TY - JOUR T1 - Highlights from this issue JF - Practical Neurology JO - Pract Neurol SP - 1 LP - 1 DO - 10.1136/practneurol-2020-002894 VL - 21 IS - 1 AU - Phil E M Smith AU - Geraint N Fuller Y1 - 2021/02/01 UR - http://pn.bmj.com/content/21/1/1.abstract N2 - This first edition of 2021 arrives along with signs that the world is beginning to get to grips with COVID-19. Several vaccines have proven effective, strategies to reduce transmission are helping to varying degrees and we have a better understanding of how to manage the disorder. This has all happened at extraordinary speed, moving from a general approach using basic principles with interventions applied from knowledge of similar disorders, through clinical trials, to an increasing evidence-based series of interventions to improve outcome.Many neurological disorders are sufficiently rare to make it difficult to get beyond using basic principles and treatment by analogy through to clinical trials. In such rare disorders it can help to discuss our learning from individual cases, recognising the limitations in the inferences drawn from them. David Bourke and Kelvin Woon describe a successful decompressive craniotomy in a patient with severe acute disseminated encephalomyelitis and raised intracranial pressure (page 53)—there is no directly relevant trial but first principles … ER -