Teaching Video Neuro <i>Images:</i> Lithium-induced reversible Pisa syndrome
Bibliographic record
Abstract
A 49-year-old man on chronic lithium therapy (1,500 mg/d) for bipolar disorder presented with a 2-year history of progressive left-lateral truncal flexion dystonia disappearing on lying supine (video 1 at [Neurology.org][1]), known as Pisa syndrome (PS), along with anterocollis and parkinsonism. Lithium serum level was normal (1.1 mmol/L). PS improved substantially 3 months after stopping lithium (video 2), supporting the diagnosis of lithium-induced PS (figure). PS has been reported with chronic use of a single or a combination of antipsychotics, but never with lithium monotherapy.1,2 Parkinsonism and PS may result from lithium-induced dopamine reuptake facilitation or dopamine receptor sensitivity reduction.2 [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000003892
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.096 | 0.011 |
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".