Sequential MRI, Cerebrospinal Fluid and Peripheral Blood Immunologic Analysis in a Natalizumab-Treated Patient With Progressive Multifocal Leukoencephalopathy
Bibliographic record
Abstract
We report a natalizumab (NTZ)-treated relapsing-remitting multiple sclerosis (RRMS) patient evaluated for worsening of pyramidal and cerebellar dysfunction. MRI showed Gd + lesions in juxtacortical frontal areas and middle cerebellar peduncles indicative of progressive multifocal leukoencephalopathy (PML). Cerebrospinal fluid (CSF) showed 47 JC virus (JCV) copies/mL, high CD8 + and plasmacytoid dendritic cells (pDCs) compared to peripheral blood (PB). MRI after NTZ discontinuation and plasma exchange revealed PML aggravation. CSF JCV increased to 475 as CD4 + , CD19 + and pDCs. CSF 8 months later showed high CD4 + , CD19 + , pDCS, not JCV. MRI showed severe focal cortical atrophy and axonal degeneration of pontocerebellar fibers. Specific immune-cell response in the central nervous system (CNS) may be essential for control of PML. J Med Cases. 2015;6(4):163-166 doi: http://dx.doi.org/10.14740/jmc2079w
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".