Conservative Management for an Infratentorial Pial Arteriovenous Fistula in an Elderly Patient: A Case Report
Bibliographic record
Abstract
Pial arteriovenous fistulas (pAVFs) are rare vascular malformations requiring intervention in neonates and infants, but the natural course in the elderly population remains unclear. We describe the case of a 78-year-old man with transient symptoms of vertigo and diplopia. Workup including magnetic resonance imaging (MRI) and computed tomography angiography (CTA) demonstrated no acute infarct or hemorrhage to explain the symptoms, but a vascular lesion was noted in the right cerebellum. Digital subtraction angiography confirmed the diagnosis of a pAVF. After review of the literature and discussion with the patient, conservative monitoring with serial imaging was elected. The patient was followed up with repeat CTA which demonstrated stable findings, and the patient remained at his neurologic baseline on long-term follow-up. pAVFs are often symptomatic lesions when found in neonates and infants, necessitating intervention. The findings of these lesions in the elderly (> 70 years of age) are exceedingly rare in the literature and may follow a benign natural course. Without direct evidence of associated symptoms or pathologic findings, conservative management with serial imaging may be a reasonable option for incidentally found pAVFs. J Neurol Res. 2022;12(3):128-131 doi: https://doi.org/10.14740/jnr726
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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 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".