Subarachnoid Hemorrhage in Perivascular Spaces Mimicking Brainstem Hematoma
Bibliographic record
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) can be devastating and associated intraparenchymal hematomas significantly increase the likelihood of neurological deficit.We report a case of a patient with an aneurysmal subarachnoid hemorrhage and a brainstem hematoma, but suffering only minimal sensory deficits.Our hypothesis is that the apparent brainstem hematoma was actually subarachnoid blood in dilated Virchow-Robin spaces.To our knowledge, this is the first report of subarachnoid hemorrhage extending into Virchow-Robin spaces. CASE REPORTA 60-year-old female was admitted with SAH.Neurological examination revealed a drowsy but easily rousable patient, oriented, without motor deficits.Computerized tomography (CT) revealed blood in the basal cisterns and Sylvian fissures, intraventricular hemorrhage, hydrocephalus and a hematoma in the ponto-mesencephalic junction (Figure 1).After external ventricular drainage, the Glasgow Coma Scale improved to 15.A computed tomography angiogram revealed three aneurysms: a larger, irregular basilar tip (Figure 1-D), a smaller left posterior communicating artery aneurysm and an extradural small right paraclinoid aneurysm.Both intracranial lesions were treated with endovascular coiling.Persistent perioral hypo-esthesia was noted in follow-up neurological examination.Magnetic Resonance Imaging three weeks after coiling showed residual blood in the brainstem with mild edema and enlarged Virchow-Robin spaces in the midbrain, basal ganglia, insula and deep white matter over the convexities (Figure 2).
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
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".