Multiple cranial couple syndrome secondary to neurosyphilis: case report
Notice bibliographique
Résumé
Male, 62-year-old, with Type 2 Diabetes Mellitus, seeks care due to altered balance and worsening palpebral ptosis. The patient had had peripheral facial palsy on the left for 40 days and was treated at another institution with oral prednisone and acyclovir for three days. Ten days ago, he had started with ipsilateral palpebral ptosis, associated with binocular diplopia and divergent strabismus also on the left in the primary gaze position. He also complained that during this period he had worsened visual acuity and frequent falls, which he related to imbalance. Upon inspection, he presented maculopapular erythema on the back, abdomen and upper limbs, with ptosis on the left. On examination, he still had a stomping and dysbasic gait, paralysis of the II, III, and IV nerves bilaterally, as well as of the VII, IX, and X on the left, with reduced visual acuity bilaterally (worse on the left), in addition to a positive Romberg test — with a fall to the left. Furthermore, there was hyporeflexia in the biceps and triceps bilaterally, associated with areflexia in the Achilles and patellas, with symmetrical distal apalesthesia in the four limbs, and cutaneousplantar in bilateral flexion. Magnetic resonance imaging of the head and neck showed uptake by the contrast medium seen at the bottom of the internal auditory canal in the distal meatal and labyrinthine segments of the left facial nerve, without signs of intracranial expansive lesion and without detectable cervical abnormalities. Laboratorially, the patient had a positive treponemal test with a Venereal Disease Research Laboratory (VDRL) value of 1:128 and the serum test for Borrelia burgdorferi showed positivity for immunoglobulin G (with negative immunoglobulin M) on admission, and such tests were repeated and negative prior to discharge, probably being altered due to cross reaction, despite the history of travel for about two years to an endemic area (Canada). Rheumatological tests, tumor and granulomatous disease markers, and serology were negative. When studying the cerebrospinal fluid, we found pleocytosis with lymphomonocytic predominance and hyperproteinorrhachia, with negative VDRL and panel for meningitis. Therefore, the hypothesis of neurosyphilis causing involvement of multiple cranial nerves was suggested and treatment with intravenous crystalline penicillin G was started for 14 days. After the first day of antibiotic therapy, the skin lesions became more prominent (Jarisch-Herxheimer reaction), with spontaneous disappearance in the subsequent days. Even during hospitalization, the patient evolved with gradual improvement of the ptosis on the left, absence of tongue deviation to the right and partial improvement in gait. Intravenous antibiotic therapy was completed, rehabilitation was indicated and outpatient return was planned.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,005 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
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 source (Gemma direct ou Codex distillé), 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 ».