2683 A perfect mini-storm: uncommon aetiology for a common presentation of bell’s palsy
Bibliographic record
Abstract
<h3>Objective</h3> To discuss a rare presentation of bilateral facial nerve palsy in a 32 year old Australian female with Lyme neuroborreliosis, SARS-CoV-2 and positive Epstein-Barr virus (EBV) serology. <h3>Case</h3> A 32 year old female presented to the emergency department with a right sided, lower motor neuron (LMN) facial palsy in the setting of a recent viral upper respiratory tract infection. Magnetic resonance imaging of the brain showed enhancement of the right facial nerve. She was diagnosed with Bell’s palsy and given a short course of oral prednisone. She re-presented 11 days later having developed a left sided LMN facial palsy. Serum EBV viral capsid antigen (VCA) IgM was equivocal in the setting of both VCA and nuclear antigen IgG positivity. Further history revealed a recent SARS-CoV-2 infection and travel to the USA and Canada. Cerebrospinal fluid (CSF) analysis showed a lymphocytosis but negative EBV polymerase chain reaction. She was treated with further steroids and antiviral therapy. Her travel to Borrelia endemic areas prompted empiric treatment with doxycycline and testing which confirmed a diagnosis of Lyme neuroborreliosis with positive Borrelia IgG and IgM. Immunoblot was positive in both serum and CSF. The patient has made a near-complete recovery. <h3>Conclusion</h3> Bilateral Bell’s palsy has been reported with Lyme neuroborreliosis, SARS-CoV-2 and EBV infection previously, but this is the first case to report co-infection. This case highlights the importance of tailoring investigations to the clinical context and serves to remind clinicians of the value of a travel history.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| 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".