Bibliographic record
Abstract
Introduction: Neuromyelitis Optica (NMO)-spectrum disorders are increasingly recognized in children. Symptomatic brain lesions, usually in the areas of high aquaporin 4 expression, may be the first presenting symptom. Associated autoimmune conditions are observed in approximately 40% of pediatric NMO cases. We present a patient with NMO-spectrum disorder who presented with intractable hiccups and vomiting. Case report: A 16 year old boy was admitted to our Neurology service with intractable vomiting and hiccups lasting for 10 days. Physical examination revealed sinus bradycardia at 40 bpm, with normal neurological examination. Serum white blood cell count, erythrocyte sedimentation rate, CRP, electrolytes (sodium, potassium, and chloride), glucose, AST, ALT and creatinine were normal. Serum-NMO IgG was positive. Brain MRI revealed a T2 weighted hyperintense lesion in the area postrema without diffusion restriction or enhancement. Intravenous steroid treatment was initiated leading to complete recovery within 24 hours. MRI of the spine and visual evoked potentials were normal. Immunosuppressive treatment was recommended. Of note, his past medical history included migraine and juvenile myoclonic epilepsy, treated with topiramate and valproic acid respectively. There was no previous history of optic neuritis or transverse myelitis. Three years prior to this presentation he experienced a sinus venous thrombosis. Investigations confirmed three prothrombotic conditions (homozygous for both factor V Leiden and MTHFR mutation, antiphospholipid antibody syndrome), necessitating anticoagulation with coumadin. Conclusion: Intractable hiccups and vomiting are characteristic for area postrema lesions, an area of high aquaporin 4 expression. The presence of these symptoms in a child already diagnosed with one autoimmune condition was a clue to the diagnosis of NMO-spectrum disorder. Because of the potentially severe prognosis following optic neuritis or transverse myelitis, early diagnosis and initiation of appropriate immunosuppressive treatment is important. NMO-spectrum disorder - hiccups - aquaporin 4 - area postrema
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 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".