Multiple cranial couple syndrome secondary to neurosyphilis: case report
Bibliographic record
Abstract
Male, 62-year-old, with Type 2 Diabetes Mellitus, seeks care due to altered balance and worsening palpebral ptosis. The patient had had peripheral facial palsy on the left for 40 days and was treated at another institution with oral prednisone and acyclovir for three days. Ten days ago, he had started with ipsilateral palpebral ptosis, associated with binocular diplopia and divergent strabismus also on the left in the primary gaze position. He also complained that during this period he had worsened visual acuity and frequent falls, which he related to imbalance. Upon inspection, he presented maculopapular erythema on the back, abdomen and upper limbs, with ptosis on the left. On examination, he still had a stomping and dysbasic gait, paralysis of the II, III, and IV nerves bilaterally, as well as of the VII, IX, and X on the left, with reduced visual acuity bilaterally (worse on the left), in addition to a positive Romberg test — with a fall to the left. Furthermore, there was hyporeflexia in the biceps and triceps bilaterally, associated with areflexia in the Achilles and patellas, with symmetrical distal apalesthesia in the four limbs, and cutaneousplantar in bilateral flexion. Magnetic resonance imaging of the head and neck showed uptake by the contrast medium seen at the bottom of the internal auditory canal in the distal meatal and labyrinthine segments of the left facial nerve, without signs of intracranial expansive lesion and without detectable cervical abnormalities. Laboratorially, the patient had a positive treponemal test with a Venereal Disease Research Laboratory (VDRL) value of 1:128 and the serum test for Borrelia burgdorferi showed positivity for immunoglobulin G (with negative immunoglobulin M) on admission, and such tests were repeated and negative prior to discharge, probably being altered due to cross reaction, despite the history of travel for about two years to an endemic area (Canada). Rheumatological tests, tumor and granulomatous disease markers, and serology were negative. When studying the cerebrospinal fluid, we found pleocytosis with lymphomonocytic predominance and hyperproteinorrhachia, with negative VDRL and panel for meningitis. Therefore, the hypothesis of neurosyphilis causing involvement of multiple cranial nerves was suggested and treatment with intravenous crystalline penicillin G was started for 14 days. After the first day of antibiotic therapy, the skin lesions became more prominent (Jarisch-Herxheimer reaction), with spontaneous disappearance in the subsequent days. Even during hospitalization, the patient evolved with gradual improvement of the ptosis on the left, absence of tongue deviation to the right and partial improvement in gait. Intravenous antibiotic therapy was completed, rehabilitation was indicated and outpatient return was planned.
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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) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 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".