Clinical Reasoning: A 73-year-old man with diplopia and ataxia
Bibliographic record
Abstract
A 73-year-old right-handed man with a history of hypertension and hyperlipidemia presented with an 18-month history of diplopia and unsteady gait. He also noted oscillating vision when turning his head to the left. The diplopia was horizontal and was worse looking at objects on his right or at a distance. Over a year, his balance worsened to the point where he required a walker due to recurrent falls. Six months prior to presentation, he developed dysphagia (liquids more than the solids). He was also noted to have short-term memory problems in the last 3 months. On examination, he had moderate cognitive impairment with a Montreal Cognitive Assessment (MoCA) score of 20/30 with predominant deficits in visuospatial functions and language. Glabellar, bilateral palmomental, and snout reflexes were present. The left pupil was surgical and nonreactive to light, and there was mechanical ptosis on the left. He had left exotropia with full eye movements, bilateral horizontal gaze-evoked nystagmus, and upbeat nystagmus on upgaze. Motor strength and tone were normal. He was diffusely hyperreflexic with bilateral extensor plantar responses. Detailed sensory examination was normal. Dysmetria was present bilaterally, more prominent on the left compared to right, with finger to nose testing and finger chase. His gait was ataxic with wide base and a tendency to fall toward the left side. He was unable to tandem walk (video on the Neurology ® Web site at [Neurology.org][1]). Systemic examination was unremarkable. [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000001975
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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) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".