The appeal of challenging cases is one of the basic attractions of Neurology as a specialty. In fact, a 2016 survey exploring what influenced a Neurology career choice noted that the intellectual content of the specialty and challenging diagnostic problems were two of the main reasons why people chose Neurology as a career.[1] Thus, this issue of Seminars in Neurology entitled Challenging Cases in Neurology was conceived by Dr. Greer as a master class in how to approach diagnostic dilemmas in various Neurology subspecialty areas.

The idea behind the issue was to provide a series of case studies that would serve as teaching material for trainees, fascinate clinicians, and remind even accomplished neurologists about subtleties in the evaluation of particular subspecialty cases. The assembled collection of manuscripts, organized by senior authors who are recognized leaders in their fields, exemplifies the principles of neurologic evaluation applicable to all aspects of Neurology. Conceptually, we proposed to the authors that they follow the format of the old Neurology Oral Boards: (1) localize the lesion; (2) provide a directed differential diagnosis; (3) come up with a diagnostic plan; (4) propose management interventions; and (5) discuss prognosis and counseling. Even with the advances in diagnostic testing and therapeutic interventions, these basic principles in establishing a proper history, examination, and clinical formulation still remain relevant to clinical practice.[2]

As this issue's editors, we have been gratified by the high quality of the provided case formulations. This collection comprises selected complex cases in cerebrovascular disease, neuromuscular disease, dementia, neuro-oncology, COVID neurology, myelopathies, movement disorders, and demyelinating disease. At last count, there were between 25 and 30 neurology subspecialty fellowships, and so there is opportunity for more issues on challenging cases in the future.

Article published online:
09 January 2023

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