How to HaNDL This Case
Bibliographic record
Abstract
Headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a self-limited, benign neurological entity that may constitute a diagnosis dilemma since it can mimic a variety of conditions including aseptic meningitis, meningoencephalitis, migraine with aura and stroke. We report a case of a 31-year-old Caucasian man admitted at the emergency department for sudden onset of dysarthria and paresthesias in the right upper limb, after 2 weeks of complaints of headache associated with mild nausea. After extensive blood investigation, CSF study, electroencephalogram and neuroimaging, central nervous system infections, autoimmune and vascular diseases were excluded. CSF study revealed lymphocytic pleocytosis, normal glucose and slightly elevated protein concentration. Magnetic resonance imaging (MRI) showed a diffuse leptomeningeal enhancement, a decreased and delayed perfusion to the entire left hemisphere. The patient improved with supportive and symptomatic management. Two days after discharge, he developed a similar clinical picture and recovered completely 30 minutes after admission. His repeated lumbar puncture (LP) showed progressive improvement as expected due to the clinical resolution and MRI did not reveal any of the previous changes. Given the presentation (clinical picture, imaging and CSF studies), the subsequent similar and self-limited episode and having excluded other causes, a final diagnosis of HaNDL was made. HaNDL is one of the most frequent stroke mimics and probably not as rare as commonly thought. It has a good prognosis since this monophasic, self-limiting condition runs its course usually within a few months from onset, without any neurological sequelae. J Med Cases. 2016;7(3):84-86 doi: http://dx.doi.org/10.14740/jmc2419w
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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 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.005 |
| Insufficient payload (model declined to judge) | 0.033 | 0.017 |
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".