More to it than meets the eye: a case report of incomitant esotropia in a child caused by a giant basilar aneurysm
Bibliographic record
Abstract
Background: Esotropia is a common concern in pediatric ophthalmology consultations. While most cases stem from strabismus, it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes, such as VI nerve palsy, hinting at the presence of intracranial space-occupying lesions. Although the occurrence of cerebral aneurysms in children is rare, they can have severe consequences. Case Description: Here, we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm × 3.9 cm × 3.9 cm in an otherwise healthy 8-year-old child, and analyzed its atypical features that suggested an intracranial etiology. We further described an endovascular approach, performed by interventional radiologists, and discussed its advantages over the conventional neurosurgery. The patient continued to be followed by our multidisciplinary team. He had a stable post-operative course and made an excellent recovery neurologically. At the 1-year follow-up, he was orthophoria with excellent vision and stereopsis. Conclusions: To our knowledge, this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly. The salient red flags—progressive incomitant esotropia and diplopia, the presence of myopia (rather than hyperopia), nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis. A multidisciplinary approach is essential for the management of such cases.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".