Superficial siderosis of the central nervous system from a bleeding pseudomeningocele
Bibliographic record
Abstract
2We present a case of superficial siderosis of the CNS that was caused by a traumatic nerve root avulsion, and we demonstrate intraoperative confirmation of the source of the chronic bleeding. Only three cases described in the literature, including the one in this report, have been surgically treated. 1,5 This 51-year-old man presented with a 7-year history of progressive difficulty with gait and hearing loss. His medical history was significant for a motor vehicle accident in 1973. At that time he suffered a severe right brachial plexus injury with nerve root avulsions at C-8 and T-1, leaving him with a flail arm. On neurological examination, the patient’s speech was markedly dysarthric, and he had diminished hearing, brisk reflexes, and cerebellar ataxia. Magnetic resonance (MR) images of the brain revealed a striking degree of superficial siderosis (Fig. 1 left and center). Gadolinium-enhanced T1-weighted images of the cervical and thoracic portions of the spine demonstrated an elongated nonenhancing pseudomeningocele extending from the T1‐2 intervertebral foramen (Fig. 1 right). Cerebrospinal fluid and cytological analyses revealed xanthochromia and hemosiderin-laden macrophages or siderophages, respectively. Surgical exploration of more than one cervicothoracic pseudomeningocele via a C5‐T1 laminectomy revealed the site of chronic bleeding into the subarachnoid space. The spinal cord appeared discolored and yellow. The pseudomeningocele associated with the T-1 nerve root was filled with clotted blood (Fig. 2). There was a slow chronic ooze of blood from a small hole in the anterior portion of the pseudomeningocele. It appeared as though a large epidural vein was in close association with the chronic bleeding. This anterior portion was coagulated and a small piece of muscle was wedged into the pseudomeningocele and sutured in place. Repeated lumbar puncture 8 months postsurgery demonstrated resolution of the xanthochromia with less than five red blood cells/mm 3
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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".