009 Asymmetric peri-optic cerebrospinal fluid space distension in cluster headache
Bibliographic record
Abstract
Distension of the optic nerve sheath is a typical neuroimaging finding seen associated with elevated intracranial pressure and a hallmark MRI feature of papilloedema. Cases of asymmetric and unilateral papilloedema have been reported though the pathophysiological mechanism remains unclear and may be multifactorial. We present a patient in her mid-thirties with episodic cluster headaches with left peri-optic nerve cerebro- spinal fluid (CSF) sheath distension identified on MRI head and orbits. No obstructive lesion was identified at the orbital apex. Optical coherence tomography revealed bilateral mild symmetrical subclinical optic nerve thinning. Optic nerve function, assessed with acuity, Ishihara colour vision and Goldman perimetry, was normal bilaterally. CSF opening pressure measured 23.5 cm H2O and constituents were bland. To our knowledge, this is the first description of asymmetric peri-optic CSF space distension in cluster headache with ipsilateral clinical and radiological phenomena. The findings raised the possibility of an asymmetric presentation of elevated intracranial pressure. Our patient, however, had no clinical or other radiological features suggestive of this. The radiological findings ipsilateral to our patient’s cluster headaches raises the difficult question about a causal relationship or simply a mere coincidence between the clinical and radiological picture.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".