The case for case reports

Editor's Note It may seem cynical for the Editors of Annals of Neurology to publish a NeuroGenesis article on the value of writing case reports, while systematically turning down the vast majority of such contributions that are submitted to us for publication. Nevertheless, we are partial to case reports (and this article) as a way to encourage scholarship among neurology residents. The advice in this article rings true to me as the Editor‐in‐Chief; a case report was my first publication in the literature as a newly minted neurologist, based on a patient I had seen as a resident. I vividly remember going through each of the steps that the authors of this NeuroGenesis article describe. In particular, the red pencil editing of my typed manuscript personally by Bud Rowland, who was then the Editor‐in‐Chief of Neurology , was a priceless component of my education as an author and an editor, as well as a human being. (Bud pointed out, among other things, that I was writing about a 29‐year‐old woman rather than a 29‐year‐old female, and he deleted the patient's race, which was commonly if superfluously used in most clinical descriptions in those days, as irrelevant.) To this day I still encourage residents to “write up” an interesting patient whose story I think has value to other neurologists. The exercise itself has educational value beyond the content of the actual manuscript. On the other hand, I urge prospective authors of case reports to read my recent NeuroGenesis article advising junior neurologists on where to publish their work. As the text above advises, “High‐impact journals rarely accept case reports based solely on clinical descriptions, but might find a truly new scientific correlation appealing.” Annals , for example, generally does not publish case reports unless they definitively identify a new mechanism of disease or treatment. However, there are many journals that do publish particularly illustrative cases for their heuristic clinical value, and even if, in the end, the case report goes unpublished (I have a few of those as well…), the effort is always educational and an important part of the training of an academic neurologist.— Clifford B. Saper, MD, PhD, Editor‐in‐Chief Case reports have seemingly fallen upon hard times. Once esteemed by William Osler and C. Miller Fisher, these reports are now considered anachronistic. Nonetheless, case reports remain valuable and formed the largest proportion of publications written last year by residents in our training program (the Partners Neurology Residency). Although they are easy to produce, it is reasonable to ask if these modern exercises are of equal significance to the narratives of migraine by John Graham in the 1950s or descriptions of Parkinson disease by James Parkinson in 1817. Even a brief reading of currently published case reports raises doubts about the value of many of them but also emphasizes their utility. We argue here that the case report format remains of considerable merit, especially to the aspiring academic clinician. Ann Neurol 2014;76:484–486