Atypical Imaging Findings in Anti-GQ1b Brainstem Encephalitis
Bibliographic record
Abstract
Brainstem encephalitis is a rare neurological entity with different etiologies. 1 When associated with ophthalmoplegia, ataxia, disturbance of awareness, in the setting of a positive antiganglioside (GQ1b) antibody serology, a diagnosis of Bickerstaff's brainstem encephalitis (BBE), a postinfectious autoimmune condition, can be made. 1-3A large majority of the patients have a monophasic course with generally good outcomes. 4e report the case of a 63-year-old male with a history of tongue cancer, treated with surgery and adjuvant radiotherapy in 2012, who presented with progressive headache, diplopia, and gait unsteadiness in 2 days.The patient denied any recent illness.Neurological examination was noticeable for ataxic gait, complex bilateral ophthalmoplegia, vertical gaze-evoked nystagmus, dysarthria, and dysphagia.Mild drowsiness was apparent.Brain MRI revealed extensive T2 hypertense brainstem lesions, some with ring enhancement post-gadolinium (Figure 1A-D).Cerebrospinal fluid (CSF) investigation documented normal opening pressure [15 cm H20 (5-20 cm H20)], mild pleocytosis [10 cells/μL, predominant lymphocytic (<5 cells/μL)], elevated protein [81 mg/dL (15-45 mg/dL)], normal glucose levels [69 mg/dl, 69% (60%-80% from blood glucose)], and a slight cerebral barrier dysfunction disorder with IgG index of 0.72 (0.3 to 0.7).Cytological examination of CSF was normal.Serum and/or CSF antibodies (Joaquim Chaves, Lisbon) were negative (Anti-Hu, -Ri, -Yo, -CV2/CRMP5, -amphiphysin, -Ta/Ma2, -Ma1, -SOX1, -GAD65, -NMDAR, -AMPA, -GABAA, -GABAB, -LGI1, -CASPR2, -GlyR, -mGluR1, -MOG, and AQP4).CSF and blood cultures were negative for bacteriological agents including Listeria and mycobacterium tuberculosis.PCR multiplex for the neurotropic virus (HSV1, HSV2, VZV, EBV, CMV, HHV6, HHV7, Enteroviruses, Parvovirus, Adenoviruses) and serology for B. burgdorferi, M. pneumoniae, and C. Jejuni were also negative.Thoracicabdominopelvic CT and PET scan did not reveal any relevant changes.Laboratory results were relevant for strong positive antiganglioside (GQ1b) antibodies (detected by EUROIMMUN immunoblot assay).Other antiganglioside antibodies (-Sulfatides, -GM1, -GM2, -GM3, -GM4, GD1a, -GD1b, -GT1b, -GD2, -GD3, -GT1a, -GT1b) were negative.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".