Recurrent Acute Necrotizing Encephalopathy in a Canadian Aboriginal Child
Bibliographic record
Abstract
Acute necrotizing encephalopathy (ANE) in childhood was originally described in the Far East.1,2 Disease onset is commonly preceded by a viral illness.1,3 Neurological deterioration occurs abruptly and rapidly.Neuroimaging is characteristic.4 Steroids and less commonly intravenous immunoglobulins have been used with variable outcomes.5 More recently, cases have been reported from Europe and North America.3,6,7 Here we present the first report of recurrent ANE in a Canadian Aboriginal child. CASE REPORTA previously healthy 34-month-old aboriginal Canadian boy from northern Manitoba presented with a four day history of cough and fever, and two day history of headache and irritability.He was sleepy the day prior to his presentation.There was no history of trauma, travel, rash or toxic ingestion.He did not have seizures.He was initially seen at the local hospital.His Glasgow Coma Scale was six.He was intubated, ventilated, and transferred to the Pediatric Intensive Care Unit at our hospital where he was started empirically on intravenous Cefotaxime, Vancomycin and Acyclovir.His past medical history is unremarkable.The mother was well during pregnancy.He was born at thirty six weeks gestation following an uneventful pregnancy and spontaneous vaginal delivery.His birth weight was 2.7 kg. His development was normal prior to his presentation.The parents are of Canadian Aboriginal Cree descent and are nonconsanguineous.Serial investigations were done including, full blood count (CBC), electrolytes, ammonia, glucose, liver function tests, cortisol, ACTH, TSH, T3, T4, vitamin B 12 , lead, antithyroid antibodies, ANCA, ANA, toxicology screen, capillary lactic acid, plasma amino acids, plasma very long chain fatty acids, whole blood palmitate oxidation assay (a rapid screening test for fatty acids oxidation defects), free and total serum carnitine levels, acylcarnitine profile, lysosomal enzymes assay panel, blood cultures; urine amino and organic acids; cerebrospinal fluid (CSF) glucose, protein, cell count, lactic acid, amino acids, oligoclonal bands, bacterial, fungal, and viral cultures including human herpes viruses (lumbar puncture was done twice, four days apart); and stool for Enteroviruses.The results were all normal except for mild elevation of CSF protein on the first lumbar puncture at 0.52g/L (normal range: 0.15 -0.4).The results of the oligoclonal bands were negative; however, there was a systemic immune reaction associated with CSF abnormality.The electroencephalogram (EEG) showed slowing in background activity consistent with an encephalopathic process.
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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 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 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".