Teaching Neuro <i>Images</i> : Middle cerebral artery aneurysm rupture presenting as pure acute subdural hematoma
Bibliographic record
Abstract
A previously well 33-year-old man with no history of trauma or substance abuse presented with poor right eye visual acuity, somnolence, and vomiting several hours after sudden onset of severe, persistent headache.Examination revealed only a right relative afferent papillary defect and subretinal blood on funduscopy (Terson syndrome, figure 1A).Hunt and Hess grade was 3.CT showed right subdural and subhyaloid hemorrhages (figure 1, B and C).Angiography re-vealed a right middle cerebral artery aneurysm (figure 2).Aneurysm rupture rarely presents as pure acute subdural hematoma.Proposed mechanisms involve direct aneurysm rupture into subdural space, from orientation, adherence to dura, or rupture through subarachnoid space by a superficial or high-pressure bleed. 1 Terson syndrome refers to intraocular hemorrhage with aneurysm rupture.Proposed pathophysiology includes retinal venous bleeding from stasis secondary to increased intracranial pressure, or from blood forced into the subarachnoid space and then along the optic nerve sheath into the preretinal space under pressure.2 Coronal (A) and sagittal (B) views demonstrating bilobed aneurysm at the middle cerebral artery trifurcation.There was no evidence of an arteriovenous dural fistula.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.014 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".