How to write a neurology case report

The rich history of neurology case reporting in the medical sciences traces back many generations to the time of Hippocrates (c. 460 B.C.) and, even earlier, to papyrus records of the ancient Egyptians (c. 1600 B.C.) [1, 2]. An early description of aphasia was written by an Egyptian surgeon actually over 4000 years ago (See Fig. 1, Edwin Smith surgical papyrus, Case 20, c2800 BC) [2]. Neurology case reports throughout the centuries have contributed to our understanding of many disease entities. Hippocrates encouraged observation and was himself a keen observer. He was among the first to describe cerebrovascular disease, noting “when persons in good health are suddenly seized with pains in the head and straightaway are laid down speechless and breathe with stertor, they die in seven days when fever comes on” [3]. This author, who sees many patients with acute cerebrovascular disease, finds his characterization of subarachnoid hemorrhage apt to this day.

The time-honored tradition of case reporting forms a cornerstone of medicine. Case reports reflect experiences of busy clinicians and provide the foundation upon which medical knowledge is built. Information accumulated from large studies and controlled trials contributes much to advancements in treatment. Nevertheless, during the course of day-to-day doctor-patient interactions, imagination and intuition often come into play to help arrive at a diagnosis or treatment plan; it is here that case reports, alongside interactions with experienced colleagues and personal experience, contribute greatly to the knowledge base from which ideas and hypotheses form [4].

The case reporting tradition began simply as personal communications between colleagues about unique and interesting patients encountered in their respective practices. The value of the reports has been consistently recognized, and the communication has evolved from anecdotal notes to a standardized format that allows indexing, categorization, and rapid dissemination of knowledge to a broad medical audience [5]. Modern case reports typically include a title, abstract, introduction, case presentation, discussion, conclusion, and references.

Even as the format evolves, the most important element remains the patient and his or her story, and constructing the case report begins with the patient. The process starts with the patient assessment, followed by discussions with colleagues, clinical investigations, treatment if possible, and follow-up examinations. Over the course of time, roughly 6 months at least but sometimes longer depending on the neurologic condition, along with multiple visits, the clinical course develops and a case report may take shape [6].

When an interesting or challenging condition arises in the hospital or private office setting, discussions with colleagues, both within neurology and across other specialties, is often the first step in the investigation. Particularly intriguing cases, or those that require an urgent transfer, may prompt reaching out to local university colleagues [6]. Beyond informal discussions, further research may lead to medical literature and case database searches. Helpful internet literature reference sites include UpToDate [7] and PubMed [8]. The availability of case reports helps tremendously in researching unique cases. BioMed Central (BMC) continues to acknowledge the value of case reports to the scientific literature through publishing the BMC series, a group of open access, peer-reviewed journals spanning most areas of biological and clinical research and where the clinical research journals provide a platform for case reports alongside research articles, and the Journal of Medical Case Reports (JMCR), the first international medical journal devoted to publishing case reports from all clinical disciplines [9, 10].

Medical list servers and online communities may be beneficial as well, such as Neurolist and The American Academy of Neurology (AAN) for discussion forums specific to neurology, and SERMO®, which encompasses most specialties [11–13]. To seek input from colleagues through more traditional, pre-Internet routes, visiting teaching grand rounds at a local university, poster presentations, and discussions with professors giving lectures at local seminars are helpful.

Once it has been determined, through discussions and research, that the case at hand presents a potential contribution to medical knowledge, assembling the pieces of the manuscript begins.

Much of the work that led to the decision to write a case report can be distilled in the introduction to explain the background of the case, including the disorder, usual presentation and progression, and an explanation of the presentation if it is a new disease. If it is a case discussing an adverse drug interaction, details of the drug’s common use and previously reported side effects should be detailed in the introduction. A brief literature review should give an overview of the case from the nonspecialist view. The introduction ends by stating briefly the central message of the report. A concise, salient introduction attracts a reader’s attention and serves as a sales pitch to entice the reader to continue [6].