Child Neurology: Pheochromocytoma Unveiled by Reversible Cerebral Vasoconstriction Syndrome in a Child With Neurofibromatosis Type 1
Bibliographic record
Abstract
A 17-year-old right-handed boy of Korean descent developed sudden onset of palpitations with a general feeling of tremulousness and subsequent flushing.This was followed by a thunderclap headache described as if his entire head exploded and the worst pain of his life.This was accompanied by vertigo, nausea, photophobia, dyspnea, and right ocular pain with conjunctival erythema and binocular blurry vision.The latter symptoms improved after 15 minutes.Two days later, the patient sought medical attention due to improved but persistent occipital and right-sided headache.A head CT and CT angiogram were performed.His CT was unremarkable while his CT angiogram showed multivessel irregular narrowing without hemorrhage (figure ,A).He was transferred to our tertiary center for further evaluation and management.The patient reported a similar episode 5 months previously.While swimming, he had sudden onset of palpitations and a severe occipital headache accompanied by vertigo and binocular blurriness.This episode resolved with rest and acetaminophen.He endorsed other milder similar episodes of exercise-induced headache in the previous 6 months.The patient's review of systems was unremarkable, with no systemic symptoms of fever, weight loss, or rash.The patient's medical history revealed a congenital left lower leg deformity and multiple caféau-lait (CAL) spots.A prior head MRI in Korea had been normal, and the family was told that he did not have neurofibromatosis type 1 (NF-1).He has a long-standing history of weekly headache suspicious for migraine.His development and cognition were normal.Regarding family history, the patient's father (unavailable for examination) was suspected to have neurofibromas without CAL spots.On physical examination, the patient's manual blood pressure was 138/82 mm Hg.His head circumference was 57.5 cm (+1 SD).His mental status was normal.We confirmed multiple CAL spots with more than 10 larger than 1.5 cm.Axillary freckling and cutaneous neurofibromas were noted.He had convex bowing of his left lower extremity.His neurologic examination revealed a normal cranial nerve examination including normal funduscopy.His tone, deep tendon reflexes, strength, and coordination were normal.He had an area of decreased sensation (temperature and pinprick) on the dorsal aspect of his left foot.He had an unremarkable cardiovascular examination exempting hypertension.Considering the clinical diagnosis of NF-1 (made on examination), our differential diagnosis for the headache and abnormal neuroimaging included NF-1 vasculopathy, transient vascular spasms, or vasculitis.An urgent MRI with vessel imaging was ordered to rule out a stroke.The imaging confirmed multivessel arterial irregular narrowing without vessel wall enhancement
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".