Oculomotor Palsy Due to Malignant Nerve Sheath Tumor: Aberrant Regeneration of the Third Nerve but Without Pupil Involvement: Response
Notice bibliographique
Résumé
We would like to thank Toohey et al for their interest in our case report. In Figure 2, they note that the examiner's finger elevates the eyelid in all positions except when the patient looks up and to the right and indicate that they believe there is elevation of the left upper eyelid when the patient looks up and to the right. They go on to suggest that aberrant regeneration of the third cranial nerve (CN3) was present, specifically left eyelid retraction in adduction. We reviewed the figure in question and our original examination photographs and we did not detect any significant difference in the size of the palpebral fissure between left and right gaze. We include here an additional set of photographs without the examiner's hand in the frame to support this so that there is no confusion (Fig. 1). The examiner's finger was not elevating the eyelid when the patient looked up, up and right, and up and left. Rather, it was simply positioned in front of the brows in the upper frames of the figure holding the patient's head steady and making sure there was no brow overaction during testing of the extraocular movements. The patient's head did slightly turn right when he looked up and right, and this may be contributing to their observation.FIG. 1.: External photographs demonstrating no significant change in the size of the left palpebral fissure in right and left gaze.Toohey et al also reported that they noticed a minimal amount of abduction of the left eye. We reviewed the original photographs and our examination report and no abduction was detected in the left eye. The patient had complete ophthalmoplegia, and the velocity of the abducting saccade could not be assessed. Considering there was complete ophthalmoplegia and no torsion of the left eye in any direction (including with attempted downgaze), the fourth nerve was also involved in this case. Regarding involvement of the first sensory branch of the trigeminal nerve, the patient did have mild decreased sensation in that distribution on the left, with associated decreased left corneal sensation. We agree with the likelihood that the left sympathetic pathways were at least partially affected as well, given the ipsilateral mid-dilated nonreactive pupil. We appreciate the author's interest in our report, but aberrant regeneration of CN3 was not demonstrably present in our patient.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».