Neural networks increasingly guide decisions in high-stakes domains such as medical diagnosis, credit approval, and energy bidding. Audit in these settings requires case-level evidence: which training cases support an action and what outcomes they carried. Case-based decision theory (CBDT) formalizes this reasoning by aggregating outcome support from remembered cases. We show that an OLS action readout fitted on a fixed neural representation admits an exact case-based decomposition. Each action score is a weighted sum of training-case returns, with coefficients determined by empirical Gram geometry. We identify a sufficient regime for CBDT similarity semantics; outside it, the coefficients should generally be treated as signed Gram-geometric influence. The decomposition yields audit signals that trace scores to training cases, measure action coherence, and identify weak support. Across synthetic CBDT, PJM, Adult Income, and Default Credit tasks, the method recovers case-level preference structure and achieves the highest mean Top-30 consistency among compared attribution baselines, while remaining competitive on support reconstruction. The audit requires only fitting an OLS top-layer probe, without retraining the representation or accessing the original optimization trajectory; probe fidelity is measured by score reconstruction.
Deep learning has brought significant progress to medical image classification, yet most existing methods still rely on isolated visual evidence and cannot effectively leverage similar cases or external knowledge. In clinical practice, diagnosis is typically supported by historical similar cases and their associated symptoms. To simulate this diagnostic process, we propose a framework that performs case-aware reasoning using multimodal knowledge graphs for explainable medical image diagnosis. Given an input image, our method constructs a multimodal knowledge graph from adaptively retrieved similar cases, enabling more effective utilization of related samples. We further introduce a knowledge propagation and injection mechanism, where an image-centric Graph Attention Network propagates knowledge semantics to obtain case-based features, followed by a bidirectional cross-modal attention mechanism that injects these features into visual representations for cross-modal alignment. To mitigate noisy retrieval, we design a confidence-calibrated decision refinement scheme that estimates the reliability of each retrieved case by jointly considering prediction confidence and sample similarity, adaptively adjusting its contribution to the final prediction and providing interpretable case-level evidence. Extensive experiments on multiple medical imaging datasets show that our approach consistently outperforms strong baselines, and ablation studies validate the effectiveness of each component. The source code is publicly available at https://anonymous.4open.science/r/MKG-CARE-8B7B.