A 58-year-old woman with progressive vertigo, deafness and weakness
Bibliographic record
Abstract
Clinical presentationThe patient was a 58-year-old, retired teacher, previously in good health.In October she developed flu-like symptoms and a sore throat that was treated with penicillin.She developed persistent vertigo and vomiting and became aware of a rapidly progressive hearing loss.She presented to her family doctor in mid-November with severe hearing loss and incapacitating vertigo.She collapsed in the waiting room and was sent to the local emergency department.She was noted on admission to have a right ptosis, generalized weakness and dehydration.A provisional diagnosis of viral labyrinthitis and possible cochleitis was made and she was started on prednisone.Three weeks had passed with no improvement when she was referred to a neurologist because of progressive proximal weakness.She was awake, alert and cooperative.Right ptosis, bifacial weakness, nasal phonation, dysarthria, and bilateral deafness were noted.Upper limb weakness was graded 1/5 proximally and 2 to 3+ distally.In the lower limbs strength was graded 4/5 except for hip flexion which was graded 2/5.Deep tendon reflexes were graded 2-in the upper limbs and were absent in the lower limbs.Plantar reflexes were flexor.The sensory exam was normal.The diagnosis of Guillain-Barre syndrome was entertained.Over the following four days she was noted to be intermittently confused and her ventilatory status deteriorated, requiring intubation and ventilation.Her prednisone was discontinued and IVIg was started.Screening bloodwork and urinalysis were normal.Her ESR was 9. Head CT with and without contrast was reported as normal.Her CSF contained 3 x10 6 RBC, 4x10 6 nucleated cells/L, a glucose of 5.6 mmol/Land elevated protein at 1222 mg/L.The following day her blood pressure became labile (ranging from 60/40 to 155/77 mmHg) and she developed rapid, unstable and refractory atrial fibrillation.She was started on amiodarone and sedated for transfer to London Health Sciences Centre (LHSC).On arrival at LHSC, her cardiac status had stabilized.She could open her eyes only momentarily, and followed commands poorly.Her pupils were slow but reactive and measured 4 mm on
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 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".