ATYPICAL PRESENTATION OF SPINAL CORD TUMORS IN CHILDREN
Bibliographic record
Abstract
Objectives: Intramedullary spinal cord tumors account for 25–35% of spinal cord tumors in children. Diagnosis is often delayed because symptoms progress insidiously reflecting the generally benign pathology. The most common presenting symptoms are back pain, gait disturbance and scoliosis. We describe two children with intramedullary spinal cord tumors who had atypical presentations of focal dystonia and status epilepticus. Methods: Case 1: An 18 month old boy presented with early right hand preference at 10 months and dystonic posturing of the left fingers of one month duration. CT and MRI scans of the brain demonstrated a left subarachnoid cyst which did not explain the dystonia of the left hand. Spinal MRI demonstrated an intramedullary mass extending from C1 to T2. Case 2: A 4.5 year old developmentally normal boy presented with generalized tonic-clonic status epilepticus during a febrile illness. A CT demonstrated ventriculomegaly. The CSF protein was elevated. MRI of the brain and spine demonstrated an intramedullary spinal mass at T9-T10 with diffuse intracranial meningeal enhancement. Results: Case 1: Laminectomy and subtotal resection were performed. Histology revealed a Grade II Astrocytoma. There was no tumor progression at 24 months follow-up. Case 2: Three leptomeningeal biopsies suggested glioma not otherwise specified. A ventriculoperitoneal shunt was inserted and the child received chemotherapy. He progressed with a supratentorial mass 16 months later which was subtotally resected. The final diagnosis was primitive neuroectodermal tumor (PNET) with glial and neuronal differentiation infiltrating into leptomeninges and dura. Despite adjuvant chemotherapy and craniospinal radiation, the patient died 2.5 years after initial presentation. Conclusion: Focal dystonia is an unusual presentation of intramedullary spinal cord tumor. Seizures may indicate leptomeningeal disease, especially with elevated CSF protein and unexplained hydrocephalus. The primary spinal tumor may be asymptomatic. Spinal imaging should be considered when such clinical features cannot be explained by intracranial pathology.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".