Large-Vessel Giant Cell Arteritis Presenting as Back Pain with Vertebral Body Infarction in a 73-year-old Caucasian Woman
Bibliographic record
Abstract
To the Editor: Giant cell arteritis (GCA) is a chronic vasculitis that almost exclusively afflicts individuals age 50 years and older, with a prevalence of 1 in 500 individuals1,2. Early diagnosis is always the goal, so symptoms such as headache, scalp pain, jaw claudication, and amaurosis fugax should alert clinicians of the possibility of GCA and lead to early confirmatory biopsy3. GCA is also known to occasionally present in an unusual manner, which can cause significant confusion and ultimately delay the diagnosis, as was the case with our patient. A 73-year-old Caucasian woman with a history of lower back pain secondary to degenerative disc disease presented to the emergency department with a one-week history of incapacitating back and neck pain accompanied by stiffness. She described the pain as sharp, beginning in her mid-back, and then slowly progressing to both her lower cervical area and her upper sacrum. She could not find a position that was comfortable, and any movement made her symptoms much worse. She also complained of “shooting” pains in her forearms bilaterally, with transient numbness of her thumbs, as well as increasing stiffness in both shoulders. She specifically denied any jaw claudication, headaches, or visual disturbances. She had had a one-year history of lumbar degeneration for which she underwent a lumbar fusion of the L5 to S1 vertebrae 4 months prior to presentation. The medical history included known C4 through C6 spinal stenosis, a herpes zoster outbreak earlier that year, gastroesophageal reflux disease, mild interstitial pulmonary … Address correspondence to Dr. Maniaci; E-mail: maniaci.michael{at}mayo.edu
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".