The case for case reports.

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.

Neuropathies in Systemic Disease.

Most peripheral neuropathies result from systemic disease. In this review, the authors highlight the main clinical features, electrographic abnormalities, histopathological aspects and treatment, as well as the current, but still incomplete understanding of the pathophysiological mechanisms involved. The peripheral neuropathic manifestations of renal failure, gastrointestinal illness, bariatric surgery, thyroid dysfunction, connective tissue disease, certain viral and bacterial infections, and critical illness are emphasized.

Management of raised intracranial pressure and hyperosmolar therapy.

The management of raised intracranial pressure is undergoing rapid change. The choice of medical treatments to reduce intracranial pressure varies between institutions and regions of the world. The mainstay of therapy, however, continues to be the infusion of a hyperosmolar solution to achieve an osmotic gradient to force the exit of water from the brain. This review introduces the basic concepts of raised intracranial pressure, summarises several recent studies that have challenged dogma in the field, and provides practical advice on hyperosmolar treatment, based on personal experience and a critical reading of the literature.