Anti-N-Methyl-D-Aspartate Receptor Encephalitis Triggered by Lyme Disease
Bibliographic record
Abstract
A 70-year-old man presented with a complete right facial nerve palsy.Past medical history was only remarkable for hypertension and gastroesophageal reflux disease.He was diagnosed with an idiopathic Bell's palsy, for which he was treated with a course of prednisone and valacyclovir.He had complete resolution of facial weakness within 3 weeks of symptom onset.Four weeks after initial symptom onset, however, he became agitated and began exhibiting bizarre behavior, including inappropriately raising his voice at people and urinating on the side of the road.He then reportedly acutely developed incoherence and bilateral arm weakness, leading to local hospital admission.Head computed tomography (CT) was unremarkable, and his acute symptomology subsided so he was discharged back home.However, his family noted that he was repetitive and continued to have bizarre behavior.Over the next 3 weeks, he had four visits to the emergency room because of aggressive outbursts, such as yelling, pushing people, and hitting his own head.He was described as having pressured speech and was pacing the room.In addition, he also complained of headache.He had remained afebrile throughout these presentations.Unenhanced head magnetic resonance imaging (MRI) and routine electroencephalography (EEG) were unremarkable.For his agitation, he was initially prescribed lorazepam and sertraline and then switched to quetiapine, without significant response.On his fourth admission, he had severe agitation requiring fourpoint restraints and treatment with haloperidol.He was assessed by the Neurology service, and aside from his behavioral change his examination including vital signs, orientation, cranial nerves, motor function, reflexes, sensation, and coordination were grossly intact.Formal bedside cognitive testing was not performed.Metabolic workup, including thyroid-stimulating hormone, vitamin B 12 , liver function, and electrolytes, were normal, except for mildly elevated creatinine at 117 micromoles per liter.Rheumatologic workup only revealed a positive antinuclear antibody (ANA) at a titer of 1:80 with speckled pattern but was otherwise negative for extractable nuclear antigen, antimicrosomal antibodies, and anti-neutrophil cytoplasmic antibody.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".