Spontaneous Extra-Cranial Vertebral Artery Dissection
Bibliographic record
Abstract
A 35-year-old doctor was on duty when she felt a moderately severe left sided neck pain.Although the pain was only partially relieved with simple analgesics, she was able to continue and finish her shift.The next day, she developed an occipital headache; at this point she sought neurologic advice for persistent head and neck pain.Physical examination was unrevealing.There was no fever, meningeal signs and no focal neurological deficits were found.A computed tomographic scan of the brain was normal while a cervical spine X-ray revealed loss of cervical lordosis.One week after the onset of neck pain a magnetic resonance arteriogram (MRA) demonstrated narrowing of the left vertebral artery at C2 to C4 (Figure 1).Fat suppression images demonstrated a rim of hyper-intense signal surrounding the vertebral artery at the level of arterial narrowing (Figure 2).Conventional catheter angiography was not performed as the diagnosis was clear on the MRA.Low-molecular weight heparin was given subcutaneously in view of the diagnosis of vertebral artery dissection.Three months afterwards anticoagulation was stopped when repeat MRA showed resolution of the lesion.The patient made an uneventful recovery.Magnetic resonance imaging (MRI) of the brain revealed no areas of silent infarction.Vertebral artery dissections can be divided anatomically into those that occur in the extracranial and the intracranial portions of the vertebral artery.The annual incidence is estimated at 1 per 100,000 but dissections are important causes of young stroke. 1 Spontaneous dissection is twice as common in women as in men.Patients with mild disease are increasingly diagnosed with the rise in noninvasive imaging.Intracranial vertebral artery dissections present with subarachnoid haemorrhage or vertebrobasilar ischemia.Extracranial vertebral artery dissections (ECVADs) usually present with occipital headache or neck pain, but vertebrobasilar ischemia may result, mostly resulting in lateral medullary, pontine, midbrain, cerebellar or thalamic infarcts.In patients presenting with severe occipital headache, especially if accompanied with neck pain, a high index of suspicion is required to prevent missing the diagnosis of an ECVAD.A history of sporting activities, chiropractic manoeuvres or neck injury may be elicited.[2][3][4][5]
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| 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".