COVID-19 Presenting With Thalamic Hemorrhage Unmasking Moyamoya Angiopathy
Bibliographic record
Abstract
Neurological manifestations of the ongoing pandemic of coronavirus disease 2019 (COVID-19) have drawn significant attention in recent times, including a high incidence of acute strokes. 1 However, stroke associated with moyamoya angiopathy has not been reported with new severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection.We report a patient with SARS-CoV-2 infection presenting with thalamic hemorrhage and acute cognitive impairment unmasking moyamoya angiopathy.A 19-year-old right-handed female college student with 14 years of continuous formal education and unremarkable medical history presented to the emergency department with acute onset of severe headache and decreased level of consciousness.She had a history of recent travel from COVID-19 endemic zone.According to her family members, she had a throbbing headache, fever, malaise, and decreased taste sensation since last 3 days.She was admitted with strict isolation protocols, and her airway, breathing, and circulation were secured.The patient's nasopharyngeal swab test for SARS-CoV-2 by qualitative realtime reverse-transcriptase polymerase chain reaction assay was positive.A brief clinical examination was notable only for Glasgow coma scale of 12/15, conjugate eye deviation towards right side with a vertical skew and mute planter response.The next day after regaining full awareness, detailed neurological examination revealed severe impairment of recent memory (predominantly verbal memory was affected, whereas visual memory was relatively preserved) and new learning, oratorical confabulations, disrupted insight, impaired recognition, and erroneous recall order.She went on having repeated queries (perseveration) and lost track of recent conversations.She also had personality changes in the form of apathy and lack of self-motivation.This was associated with acalculia without language dysfunction, apraxia, alexia, agraphia, executive dysfunction, and neglect.Apart from these cognitive difficulties, she had right upper arm dystonic posturing and clumsiness without any other abnormalities in sensory, motor, cerebellar, and autonomic functions.Complete metabolic panel revealed no abnormality.A contrast enhanced magnetic resonance imaging of brain showed an acute left thalamic intracerebral hemorrhage (Figure 1), meanwhile a digital subtraction angiography revealed features of moyamoya angiopathy (Figure 2).Other directed investigations to establish etiology of moyamoya angiopathy were futile, and the diagnosis of moyamoya disease associated with COVID-19 was finalized.Patient was managed conservatively and discharged after 2 weeks with a plan for performing revascularization.Repeat cognitive assessment
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.009 | 0.006 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
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".