Oculomotor Palsy Due to Malignant Nerve Sheath Tumor: Aberrant Regeneration of the Third Nerve but Without Pupil Involvement: Response
Bibliographic record
Abstract
We would like to thank Toohey et al for their interest in our case report. In Figure 2, they note that the examiner's finger elevates the eyelid in all positions except when the patient looks up and to the right and indicate that they believe there is elevation of the left upper eyelid when the patient looks up and to the right. They go on to suggest that aberrant regeneration of the third cranial nerve (CN3) was present, specifically left eyelid retraction in adduction. We reviewed the figure in question and our original examination photographs and we did not detect any significant difference in the size of the palpebral fissure between left and right gaze. We include here an additional set of photographs without the examiner's hand in the frame to support this so that there is no confusion (Fig. 1). The examiner's finger was not elevating the eyelid when the patient looked up, up and right, and up and left. Rather, it was simply positioned in front of the brows in the upper frames of the figure holding the patient's head steady and making sure there was no brow overaction during testing of the extraocular movements. The patient's head did slightly turn right when he looked up and right, and this may be contributing to their observation.FIG. 1.: External photographs demonstrating no significant change in the size of the left palpebral fissure in right and left gaze.Toohey et al also reported that they noticed a minimal amount of abduction of the left eye. We reviewed the original photographs and our examination report and no abduction was detected in the left eye. The patient had complete ophthalmoplegia, and the velocity of the abducting saccade could not be assessed. Considering there was complete ophthalmoplegia and no torsion of the left eye in any direction (including with attempted downgaze), the fourth nerve was also involved in this case. Regarding involvement of the first sensory branch of the trigeminal nerve, the patient did have mild decreased sensation in that distribution on the left, with associated decreased left corneal sensation. We agree with the likelihood that the left sympathetic pathways were at least partially affected as well, given the ipsilateral mid-dilated nonreactive pupil. We appreciate the author's interest in our report, but aberrant regeneration of CN3 was not demonstrably present in our patient.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.012 | 0.009 |
| Insufficient payload (model declined to judge) | 0.004 | 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".