Posterior Reversible Encephalopathy Syndrome in Acute COVID-19 Pneumonia
Bibliographic record
Abstract
A 66-year-old woman presented to the Emergency Department with shortness of breath and was found to be febrile and tachycardic.Chest CT showed bilateral ground-glass opacities, and she was admitted with a diagnosis of COVID-19 pneumonia.PCR testing confirmed that she was positive for the SARS-CoV-2 virus.Medical co-morbidities included asthma, type 2 diabetes, hypertension, and dyslipidemia.Shortly after admission, she was intubated and transferred to the ICU, where she remained for 40 days.There were no sustained episodes of hypertension.Bacterial superinfection led to Pseudomonas pneumonia, and her course was further complicated by subclavian deep vein thrombosis.As she began to regain consciousness, she was confused and disoriented with headache, complaining that she could not see.Family members found that she did not recognize them when they entered the room, only when she could hear their voices.Two non-contrast CT scans of the brain were performed and were both interpreted as normal.When vision blurring persisted, MRI brain with diffusion-weighted imaging (DWI) was performed and showed extensive bilateral areas of T2/FLAIR hyperintensity (Figure 1), consistent with vasogenic edema and posterior reversible encephalopathy syndrome (PRES).Over the ensuing weeks, her vision recovered completely.Acutely ill patients with COVID-19 are at risk for neurologic complications including stroke, viral meningitis/encephalitis, cerebral venous thrombosis, hypoxic encephalopathy, and demyelinating disease. 1 PRES must be included in the differential diagnosis, 2 and appropriate neuroimaging in the form of MRI with DWI performed. 3PRES is a result of an incompletely understood process of failed endothelial regulation resulting in cerebral vasogenic edema and was initially described in patients with immunosuppressive drugs, renal insufficiency, or severe hypertension. 4Occipital and parietal lobes are most frequently affected, and symptoms include headache, altered sensorium, seizure, and vision loss.Prompt treatment to reverse the causative stimulus results in recovery of function in most cases.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 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".