Hand knob stroke from cancer-associated thromboembolism
Bibliographic record
Abstract
A 72-year-old man undergoing chemotherapy with 4 cycles of gemcitabine and nabpaclitaxel for pancreatic ductal adenocarcinoma, diagnosed 5 months previously, presented to the emergency department with sudden difficulty moving his left hand.Neurological examination showed paresis of extension of the left wrist.Weakness of all fingers of the left hand was present, including a teardrop sign from paresis of the finger flexors (Figure 1A).Sensory examination results were normal.Diffusion-weighted brain magnetic resonance imaging (MRI) showed an acute infarction in the superior part of the patient's right precentral gyrus, called the hand knob area (Figures 1B, 1C).No substantial internal carotid artery stenosis was visualized on MRI angiography.Contrast-enhanced full-body computed tomography, obtained for suspected thrombosis, showed the pancreatic tumour, unchanged in size, and pulmonary embolism in the right pulmonary artery (Figures 1D, 1E).After careful exclusion of cardioembolism through cardiac monitoring and transthoracic echocardiogram, we diagnosed stroke in the hand knob area, from cancer-associated embolism.The patient's symptoms gradually improved after treatment with lowmolecular-weight heparin (LMWH).Infarction in the hand knob area, the site of hand motor function, can cause isolated upper limb paresis and may be misdiagnosed as peripheral nerve damage.This is an uncommon presentation of acute stroke, with an incidence rate of < 1% among all ischemic strokes. 1 This manifestation is typically associated with atheroembolism or cardioembolism.Patients with malignant disease are in a hypercoagulable state and at risk for the development of thromboembolism that may be arterial or venous in origin.Pathogenesis of the hypercoagulable state of malignancy has not been fully elucidated, but involves the interplay of multiple mechanisms, including those associated with carcinoma mucins, tissue factor and cancer procoagulant.2 Standard treatment includes early initiation of LMWH, with direct oral anticoagulants being a preferable alternative.Although hand knob infarction has a good functional outcome, cancer-associated thromboembolism has a higher incidence of recurrence and is the second leading cause of death in patients with cancer.
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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 | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".