E-169 A shot from the heart: large vessel occlusion from papillary fibroelastoma
Bibliographic record
Abstract
A 19-year old female presented to the emergency department with EMS as a code stroke, after she was found with global aphasia and right hemiparesis. The patient has a history of migraine and syncope episodes occurring 2 to 3 times per year since early childhood without an apparent cause. Otherwise, she is healthy without family history suggestive of underlying hypercoagulable disorders and no lifestyle vasculopathic risk factors. Her initial examination demonstrated profound expressive and receptive aphasia, left gaze preference, right homonymous hemianopsia, right facial droop, right hemiplegia, and partial right sensory sensory alteration, consistent with a left middle cerebral artery stroke syndrome. CT angiography showed a left M1 vessel occlusion with ASPECT of 10.Acute reperfusion therapy with endovascular thrombectomy was achieved successfully. She was monitored in the ICU unit followed by transition to the inpatient neurology ward. Subsequent Investigations including blood tests revealed a normal CBC, renal and coagulation studies. Hypercoagubviliy work-up including APLA, PNH and JAK2 were negative. TEE showed a small, mobile, simmering appearing mass within the left atrial appendage measuring 0.8 cm by 0.7 cm, suspicious for papillary fibroelastoma in an atypical location. Subsequent pathologic analysis of the aspirated tissue confirmed the diagnosis of papillary fibroelastoma. She underwent cardiac surgery to resect the mass. Histopathology confirmed the diagnosisThe case emphasizes the importance of sending clots to histopathology in cases with no clear stroke etiology. Our case is one of the few that have documented embolus from a cardiac papillary fibroelastoma causing large vessel occlusion stroke. Disclosures J. Li: None. G. Besant: None. A. Muccilli: None. J. Diestro: None.
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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 | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
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".