Bird watching on the asphalt

Attempting to make a diagnosis from a collection of baffling symptoms is comparable to the challenge of identifying an unusual bird that refuses to stay still. Many neurologists take up birding as a hobby where they can apply their observation and listening skills and be free to celebrate the thrill of accurate diagnosis without censure1. A few also become ornithologists, writing in scientific publications on avian anatomy, physiology and behaviour, and even on the neurological disorders of birds. In this essay I describe how bird watching and a love of natural history turned me not only into a noticer but also influenced my choice of medical speciality

Listening with intent

Listening in medicine is only of value when it is combined with an ability to decipher the patient's utterances and gestures and act upon them

Georges Simenon, Inspector Maigret and his relevance to the practice of Neurology

Georges Simenon's work, including his famous 'romans durs' novels and the forensic investigations carried out by his artistic creation, Inspector Maigret, bear many similarities to some of the diagnostic methods of the founders of Neurology, particularly Jean-Martin Charcot

How to understand it: Visual hallucinations

Visual hallucinations have intrigued neurologists and physicians for generations due to patients’ vivid and fascinating descriptions. They are most commonly associated with Parkinson’s disease and dementia with Lewy bodies, but also occur in people with visual loss, where they are known as Charles Bonnet syndrome. More rarely, they can develop in other neurological conditions, such as thalamic or midbrain lesions, when they are known as peduncular hallucinosis. This review considers the mechanisms underlying visual hallucinations across diagnoses, including visual loss, network dysfunction across the brain and changes in neurotransmitters. We propose a framework to explain why visual hallucinations occur most commonly in Parkinson’s disease and dementia with Lewy bodies, and discuss treatment approaches to visual hallucinations in these conditions

The motor prodromes of parkinson's disease: from bedside observation to large-scale application

There is sufficient evidence that the pathological process that causes Parkinson's disease begins years before the clinical diagnosis is made. Over the last 15 years, there has been much interest in the existence of a prodrome in some patients, with a particular focus on non-motor symptoms such as reduced sense of smell, REM-sleep disorder, depression, and constipation. Given that the diagnostic criteria for Parkinson's disease depends on the presence of bradykinesia, it is somewhat surprising that there has been much less research into the possibility of subtle motor dysfunction as a pre-diagnostic pointer. This review will focus on early motor features and provide some advice on how to detect and measure them