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March 20, 2018

Neurological Symptoms Among US Diplomats in Cuba

Author Affiliations
  • 1Associate Editor, JAMA, Chicago, Illinois
  • 2Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
  • 3Division of Neurology, Lehigh Valley Health Network, Allentown, Pennsylvania
JAMA. 2018;319(11):1098-1100. doi:10.1001/jama.2018.1780

The primary value of publishing case reports and case series in the medical literature involves the documentation of symptoms, signs, and clinical data in a unique group of individuals. Often at the time of initial report, the fundamental etiology and pathophysiologic mechanism underlying the clinical phenomena are not yet fully understood, but the clear description of potentially pertinent data serves as a foundation on which other clinicians and investigators can build.

For example, in 1881, Wernicke described a syndrome of acute confusion, ophthalmoplegia, and ataxia and, in 1887, Korsakoff described a series of patients with predominantly anterograde amnesia. Yet, it was not until several years later (and after several additional cases were published) that the 2 conditions were recognized as part of a clinical syndrome—Wernicke-Korsakoff syndrome—often associated with chronic alcoholism.1 The concept of vitamin deficiency was not well established at the time and the link between Wernicke-Korsakoff syndrome and thiamine deficiency was not determined until the 1930s,1 illustrating that medical diagnosis at any given time depends to some extent on the current state of scientific knowledge, historical and cultural context, and the framework through which a disease is conceptualized.2

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