Demyelination After Primary Central Nervous System Lymphoma; Reversed ‘Sentinel’
Bibliographic record
Abstract
A 50-year-old, previously healthy woman presented with memory impairment and handwriting changes.Brain magnetic resonance imaging (MRI) showed hyperintense lesions in t2 and fluid-attenuated inversion recovery (FlAIR) sequences in the left thalamus (Figure 1A andB).Diffuse large B-cell lymphoma was found in a specimen obtained by stereotactic brain biopsy.there were no signs of extraneural lymphoma dissemination.A diagnosis of primary central nervous system (CNS) large B-cell lymphoma (primary central nervous system lymphoma (PCNSl)) was made.the patient was treated with high-dose methotrexate and whole brain irradiation with completed resolution of clinical symptoms and radiological findings.two years later she developed headaches accompanied by dysgeusia, olfactory hallucinations and light-headedness.Brain MRI showed one hyperintense lesion of the right temporal lobe in t2 and FlAIR sequences with homogenous contrast enhancement surrounded with perifocal edema (Figure 1C and D) consistent with relapsed lymphoma.to confirm the relapse a brain biopsy was performed which showed findings consistent with acute disseminated encephalomyelitis (ADeM) (Figure 2). the patient was admitted to our department for further assessment.At that time her neurological examination was unremarkable and her symptoms ameliorated without receiving corticosteroid treatment.Also, the lesion in the right temporal lobe appeared significantly smaller and enhancement was not observed on repeated MRI.Cerebral spinal fluid (CSF) analysis showed 8 cells/mm 3 , predominately small lymphocytes; there were no oligoclonal Igg bands.Cytological and microbiological CSF analyses were unremarkable.extensive work-up to exclude secondary demyelinating lesion was performed including immunological evaluation, HIv, hepatitis, toxoplasma gondii, Treponema pallidum, Borrelia burgorferi, EBV and CMV serology, angiotensin-convertase and beta2-microglobulin levels.All findings were normal.She was diagnosed as having ADeM and not treated with corticosteroids.Follow-up MRIs, three and six months later, showed no lesions in the right temporal lobe.As well, cognitive evaluation on follow-up was normal.twelve months later the patient is in remission without symptoms.
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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) | 0.001 | 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 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".