Cerebral Venous Thrombosis Presenting as Subacute Parkinsonism
Bibliographic record
Abstract
Cerebral venous thrombosis (CVT) is an uncommon form of cerebrovascular disease, with an incidence of three to four cases per million persons.Although acute-onset headache is the most consistent presentation, CVT may also manifest as seizures, intracranial hypertension, and focal sensorimotor deficits 1 .Here, we report the unusual development of subacute parkinsonism secondary to multiple cerebral sinus thromboses. CASE REPORTA 57-year-old right-handed woman with a three year history of diffuse, intermittent headaches presented to the Jewish General Hospital (Montreal) with worsening non-pulsatile headache and progressive hypophonia, micrographia, bradyphrenia and gait unsteadiness over a three week period.There were no complaints of hyposmia, sleep disturbances, constipation or other pre-motor symptoms of idiopathic Parkinson disease.Her past medical history was unremarkable and her medication list included vitamin D and calcium supplements only.Physical examination revealed normal vital signs with no evidence of postural hypotension, normal level of consciousness, orientation, attention, language, affect, judgment and insight.There was facial hypomimia but the rest of the cranial nerve exam, including bilateral olfactory nerve testing, was normal.There was marked hypophonia and micrographia and moderate bradykinesia and cogwheel rigidity.Muscle power was normal and tremor was absent.The gait was narrow-based, small-steppage and unsteady.There was severe retropulsion on pull-testing.Sensory, cerebellar and reflex testing was unremarkable save for prominent glabellar tap and palmomental signs.A computed tomogram (CT) scan of the head (Figure) showed small, scattered hyperdensities in bilateral frontal, temporal and parietal lobes and in the region of the interpeduncular cistern.The white matter appeared abnormally hypodense consistent with generalized edema (a1-a2).Magnetic resonance imaging axial FLAIR sequences showed heterogeneous hyperintense signal of the transverse sinuses (left, arrow) and congested peripheral veins (b1-b2).Axial FLAIR and T2 sequences showed diffuse, hyperintense signal of the periventricular and subcortical white matter and mild sulcal effacement (c1-c2).Magnetic resonance venography (MRV) demonstrated occlusion of the transverse sinuses and distal internal cerebral veins, minimal flow within the vein of Galen, and severely congested cortical and subcortical veins and straight sinus (d1-d2).Routine hematology, erythrocyte sedimentation rate and
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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 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| 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".