Ataxia and Diplopia in a Patient with Chronic Lymphocytic Leukemia
Bibliographic record
Abstract
CLINICAL PRESENTATION -DR. GOFTONA female in her early 60's presented with a four month history of double vision and frequent falls.The falls had increased over the two weeks prior to presentation leading to bruises of varying ages on her right side and an abrasion below her right orbit.The patient's family had also noticed confusion and slowed speech.The patient's past medical history was significant for a nine year history of chronic lymphocytic leukemia (CLL), a hysterectomy and oophorectomy for benign disease, carpal tunnel syndrome, depression and elevated cholesterol.She was a nonsmoker and did not consume alcohol.There was no significant family history or consanguinity.There was no recent travel.Medications at the time of presentation consisted of: paroxetine 20mg po once daily, vitamin B1 po once daily, atarvastatin 20mg po once daily, acetylsalicylic acid 81mg po once daily and chlorambucil 2mg po bid.At the time of presentation, the patient had normal vital signs and was in no acute distress.Systemic examination was unremarkable and there was no lymphadenopathy.Examination of the cranial nerves revealed right esotropia and hypometric saccades to the right.The visual fields and fundi were normal.The remainder of the cranial nerve examination was unremarkable.Motor examination revealed normal bulk, tone and power.Sensory examination was normal in all modalities.Reflexes were 2+ and symmetrical.The plantar response was downgoing on the left and upgoing on the right.Examination of gait demonstrated a high stepping gait on the right, falls to the right with ambulation and an inability to perform tandem gait.Right arm dysmetria was present on finger-nose testing and there was dysdiadochokinesia on the right side. CASE DISCUSSION -DR. MACDONALDLocalization of the case presented above is based on several signs and symptoms.The main complaints at presentation were diplopia and falls to the right.Diplopia localizes to the brainstem and may be caused by a IIIrd, IVth or VIth cranial nerve lesion in the midbrain and pons or along the course of the nerve
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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) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| 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".