Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest
Bibliographic record
Abstract
We present the case of a 53-year-old woman who presented with right lower extremity weakness with preceding systemic symptoms including fever and chest pain.She developed rapid quadriparesis over 24 hours and had ventricular fibrillation with cardiac arrest.Examination demonstrated tetraplegia, facial diplegia with spared extraocular movements, and areflexia.Electrodiagnostic studies including nerve conduction studies and EMG were consistent with acute motor axonal neuropathy.This case highlights an atypical asymmetric presentation with initially preserved reflexes, rapid progression, and cardiac dysfunction that can occur independent of dysautonomia.Treatment options include IV immunoglobulin (IVIg) or plasmapheresis as well as supportive care and long-term multidisciplinary rehabilitation and communication strategies. Pearls cAsymmetric onset and rapidly progressive weakness should raise the suspicion for Guillain-Barré syndrome (GBS) and its variants.c Although uncommon, acute motor axonal neuropathy (AMAN) can be complicated by dysautonomia, requiring close monitoring for cardiac arrhythmia and rarely ventricular fibrillation.Oy-sters c Preserved reflexes do not exclude the possibility of AMAN, where areflexia can occur later on.cAlthough CSF albuminocytologic dissociation is a classic finding in GBS, mild pleocytosis may also occur. CaseA 53-year-old woman presented to hospital for sudden onset of right leg weakness.After dropping her children to school, she was unable to support her body on her right leg with difficulty walking back to her car.She was able to get into the car, and ankle strength was sufficient to operate the pedals.On getting out of the car, her right leg buckled again.She was unable to stand and called an ambulance.She endorsed some low back pain without any radiating pattern.Her medical history was significant for hypothyroidism and dyslipidemia, treated with levothyroxine and rosuvastatin accordingly.On initial examination, she was afebrile with normal vital signs.She was alert and oriented, with normal language testing.Pupils were equal and reactive to light.Visual fields and extraocular movements were full.She had full facial sensation and strength.Tongue and palate were midline.Shoulders and neck were strong.Upper extremities and left leg demonstrated normal strength, sensation, deep tendon reflexes, and coordination.Right leg demonstrated grade 2/5 strength in hip flexion and 3/5 in knee flexion and extension, but otherwise 5/5 in ankle movements with normal sensation.Her Achilles reflexes were present bilaterally, but patellar reflexes were absent.Plantar response was flexor bilaterally.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".