Obstetric Management of a Novel Superimposition of Facial Onset Sensory and Motor Neuronopathy on Parsonage Turner Syndrome
Bibliographic record
Abstract
Parsonage-Turner syndrome (PTS) is a rare neurologic disorder characterized by pain and weakness in the distribution of the brachial plexus. In severe cases, the phrenic nerve may be involved resulting in hemidiaphragm paralysis. Facial onset sensory and motor neuronopathy (FOSMN) is another rare disease that typically progresses slowly, with facial paresthesias preceding the onset of bulbar symptoms. A lack of corneal reflex is pathognomonic for FOSMN. This case is regarding a 35-year-old G7P1051 with known multi-episodic PTS involving the phrenic nerve that had been successfully managed for several years with intravenous immunoglobulin (IVIG) therapy. She presented at 28 weeks gestational age for an acute PTS flare with left upper extremity pain and weakness, and dyspnea. She received IVIG therapy with improvement of her symptoms and was discharged. She returned the day after discharge with left upper extremity paralysis, dysarthria, facial allodynia, and worsening dyspnea and dysphagia. After further evaluation by the Neurology, she received an additional diagnosis of FOSMN, a condition with limited treatment options. Despite aggressive immunotherapy, her dyspnea worsened, and she developed anarthria, trismus, and aphagia. She was delivered at 31 weeks gestational age due to continued clinical deterioration. By postpartum day 4, her dyspnea and dysphagia were resolved, and her speech was markedly improved. This is the first report of FOSMN onset in pregnancy, superimposition on PTS, and symptom abatement after delivery. This report is unique because it discusses management for conditions for which there are no formal neurologic or obstetric society guidelines on management in pregnancy. Our report highlights that in gravid individuals with maternal disease processes managed with immunotherapy, consideration should be given to the possibility that placental physiology may render previously effective immunotherapy less effective or ineffective during pregnancy. J Clin Gynecol Obstet. 2023;12(3):88-92 doi: https://doi.org/10.14740/jcgo909
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".