Goggle-like Appearance of Injured Cerebellothalamic Axons Surrounding Red Nuclei in Holmes Tremor
Bibliographic record
Abstract
A 66-year-old man on rivaroxaban (Xarelto) for atrial fibrillation experienced a pontine hemorrhage.He survived the acute hospitalization and was discharged to a rehabilitation facility in a quadriparetic state.Over the 4 months following the hemorrhage, he developed a tremor, first in the lower and then in the upper extremities, which prompted his referral to the Movement Disorders clinic.On examination of visual tracking, there was no horizontal movement of the left eye and no adduction of the right eye.He had distal more than proximal, left more than right, and lower more than upper limb weakness, ranging from 3/5 in the left leg to 4/5 in the right arm, with depressed deep tendon reflexes.In the left upper extremity, he had a tremor that was present at rest, with posture, and with action.The movements met the description of Holmes tremor in the Consensus Statement of the Movement Disorder Society on Tremor. 1 The movements lacked the jerky quality of myoclonus, the randomness of chorea, or the sustained twisting quality of dystonia, nor was there any pulling toward a null position as in dystonic tremor.There was also head tremor with activation of the left shoulder girdle and neck muscles.When he held the left arm outstretched, supporting it against gravity, and the examiner shoved the limb out of position, the limb oscillated for several cycles before settling into position again.Pointing (finger-chin-finger) was ataxic, and there were mild athetoid movements of the fingers.A similar resting tremor was present in the left lower extremity, although weakness there precluded testing postural or kinetic tremor.A postural and kinetic tremor similar to that of the left upper extremity was seen in the right upper extremity as well, but not as severe.There was no bradykinesia or rigidity.We recommended a trial of levodopa, [2][3][4][5][6] and, if this failed, leviteracitam, 7,8 but the patient died before results of this could be determined.Magnetic resonance imaging of the brain done at 1 day after the acute hemorrhage shows the pontine hemorrhage (Figure 1A).Higher cuts, at the level of the midbrain, show a striking "gogglelike" appearance of T2 hyperintensity representing anterograde axonal edema extended rostrally to midbrain (Figure 1B) where it is seen in cerebellothalamic fibers surround the red nuclei.It is well-known that mesencephalic lesions may cause a lowfrequency tremor present at rest, with posture, and with action (Holmes tremor).The term "rubral" for such tremors implies a role for the red nucleus (RN), but the critical structure may instead be cerebellar efferents, 9 some of which synapse in the
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 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".