P.066 A 65 year-old male with subacute asymmetric, proximal more than distal upper extremity weakness with associated paresthesias and pain
Bibliographic record
Abstract
Background: Neuroborreliosis affects approximately 10-15% of people with untreated Lyme disease and typically declares itself 2-18 weeks after infection. North American neuroborreliosis often manifests with cranial nerve palsy, meningitis, and/or radiculoneuritis. Methods: Here we describe a case of North American neuroborreliosis and also highlight some of the rare manifestations of systemic Lyme disease. A 65-year old male presented with a subacute history of progressive upper extremity weakness, neck pain, and headache. This occurred in the context of a recent tick exposure. Results: MRI of the brachial plexus, serology and CSF studies, and EMG/NCS were consistent with a diagnosis of polyradicular neuroborreliosis. However, whole body imaging identified some concerning features suggestive of lymphoma: specifically a large necrotic mediastinal lymph node and a number of vascular abnormalities. In light of these findings, the differential also included neurolymphomatosis and a PET scan was conducted. Reassuringly, there was no increase in FDG avidity in the distribution of his affected nerves. Moreover, his neurologic symptoms exhibited clinical improvement following treatment of his neuroborreliosis. Conclusions: This case provides an excellent example of the clinical features of neuroborreliosis, but more importantly also highlights some of the rarer potential manifestations, which warrant further investigation.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.003 |
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".