Corpus Callosum Atrophy in a Patient with Neuromyelitis Optica
Bibliographic record
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system characterized by recurrent episodes of optic neuritis and transverse myelitis 1 .The most prominent magnetic resonance image (MRI) finding in NMO is longitudinally extensive transverse myelitis.We report a woman with corpus callosum atrophy on brain MRI, who was initially diagnosed as having multiple sclerosis (MS). CASE REPORTThis otherwise healthy Caucasian woman had presented at the age of 20 with left optic neuritis, which had resulted in complete loss of vision in this eye, followed by several episodes of transverse myelitis and contralateral optic neuritis, with partial recovery.One year later, she was diagnosed with MS, and treated with varying doses of oral prednisone and azathioprine.She continued to have repeated episodes of optic neuritis and transverse myelitis.Five years since onset, interferon beta1-b 250 mcg SC qod was started in combination with azathioprine.She had no further neurologic episodes over the following year, until azathioprine was discontinued due to neutropenia, and interferon beta1-b was continued at half dose.Subsequently, she had recurrent episodes of optic neuritis and transverse myelitis, treated with high dose steroids at least twice a year.Eight years after presentation, interferon beta1-b was discontinued, and she started glatiramer acetate 20 mg qd.She continued to experience optic neuritis at least twice a year, treated with high dose steroids.When she presented to us 18 years after initial presentation, her best visual acuity was finger counting at three meters on the right, and no light perception on the left.Pupils were dilated and unreactive to light on the left, with a sluggish response to light on the right.She had left exophoria and nystagmus in all directions of gaze.She had a spastic quadriparesis, and was able to take a few steps with a walker.Laboratory investigations revealed weakly positive ANA, elevated rheumatoid factor of 158 IU/mL, negative anti-dsDNA, negative anti-ENA screen, normal vitamin B12 levels.Serum NMO antibody was reported positive by Mayo Clinic laboratory in Rochester Minnesota, USA.Brain MRI showed callosal atrophy, centrally in the body.A few nonspecific high T2 signal white matter abnormalities were seen in the deep white matter of the hemispheres.No lesions were seen in the posterior fossa or the periventricular areas.The spinal cord was markedly atrophic, and no signal change was seen in the spinal cord.No abnormal enhancement was seen with Gadolinium (Gd) injection.(Figure ) We recommended discontinuation of glatiramer actete; azathioprine was initiated.At the time of preparation of this
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| 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".