The simple form of case uses an implied equals to (=) comparison. With the extended form, the comparison operator can be specified explicitly.
SELECT CASE <Expression> WHEN < 0 THEN 'negative'
WHEN = 0 THEN 'zero'
ELSE 'positive'
END
FROM …Related
Tutorial:
Case— Conditional ExpressionsBetter supported alternative:
case when …(searched case).
Normative References
The extended case expression is defined in ISO/IEC 9075-2:2023 as optional feature F262, “Extended CASE expression”.

