An Unusual Presentation of Neurosarcoidosis in an 11-Year-Old Boy
Bibliographic record
Abstract
Sarcoidosis is a chronic, multisystem, granulomatous disease which typically develops between the ages of 20 and 40 years 1 .Neurosarcoidosis occurs in only 5-15% of adults with sarcoidosis, and is seldom reported in children 2-5 .Of the cases described in the literature, children were found more likely to present with seizures, and less commonly space-occupying lesions 6 .The tumefactive brain lesions are difficult to distinguish from the tumefactive demyelinating lesions of multiple sclerosis, from brain neoplasms, acute disseminated encephalo-myelitis (ADEM), or from parasitic foci 7,8 .We report the clinical and radiographic features of an 11-year-old boy with biopsy-proven neurosarcoidosis in order to highlight key features that distinguish neurosarcoidosis from tumefactive demyelination. CASE REPORTA previously healthy 11-year-old male presented in status epilepticus.The seizure started with an altered level of awareness and focal twitching of the right side of his face.The ictus lasted 45 minutes and responded to intravenous administration of lorazepam and phenytoin.Investigations revealed a peripheral white blood cell count of 28.2 (4.5-13 X10 9 /L), and normal hemoglobin and platelets.Electrolytes, glucose, renal and liver function, and coagulation parameters were normal.A toxicology screen was negative.Bacterial, viral, and fungal cultures were negative in blood.Cerebrospinal fluid (CSF) analyses revealed 20 X 10 6 /L leucocytes (90% lymphocytes), normal glucose and protein, no malignant cells, and negative bacterial and viral cultures.Polymerase chain reactivity for Herpes viruses was negative.Oligoclonal banding was detected, but as serum electrophoresis was not performed, this finding could not be evaluated.Serum anti-nuclear factor was negative.Computerized tomography of the head showed a focal, nonenhancing mass of the left frontal lobe with no evidence of mass effect or hydrocephalus.As shown in Figure 1, magnetic resonance imaging (MRI) demonstrated a region of increased T2/FLAIR signal involving the white matter of the left frontal lobe with leptomeningeal enhancement after gadolinium contrast administration.Magnetic resonance spectroscopy (MRS) demonstrated a lactate peak with normal choline and Nacetylaspartate.A second MRI obtained one week later showed improvement, with normalization of mass spectroscopy.Following recovery from the post-ictal period, the child was noted to have a normal neurological and general physical examination, including normal cognition and no focal deficits.Given the normal examination, and repeat MRI showing improvement in the lesion appearance, brain biopsy was
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 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".