Subacute Acquired Chorea in a Child: An Unexpected Co-occurrence
Bibliographic record
Abstract
A 5-year-old indigenous female presented with a 1-week history of progressive generalized involuntary movements.Due to the severity of her movements she was unable to eat, talk, walk, or participate in daily activities.Prior to her presentation to hospital she had 1 and a half weeks of a minor cough with rhinorrhea.Over the previous few months her mother reported a history of recurrent upper respiratory tract infections with cough with no obvious sore throat, and possible subjective weight loss.On a review of her symptoms there was no history of fever, rash, or other signs and symptoms of hyperthyroidism, musculoskeletal, or rheumatologic conditions including arthralgia.Her past medical history included an uncomplicated pregnancy and delivery, mild gross motor delay and speech/ cognitive delay.There was no past medical history of chorea or other abnormal movements.Family history including 3 brothers and 1 sister was unremarkable.There was no consanguinity.The physical examination revealed significant generalized slow arrhythmic involuntary movements consistent with chorea in all limbs, torso, and neck.The chorea resolved during sleep.There was motor impersistence with milk-maid grip and nonsustained tongue protrusion.Neurologic examination was otherwise unremarkable with no obvious cranial nerve, strength, or sensory deficits.Due to chorea her coordination and reflexes could not be assessed.Cardiac, respiratory, and abdominal examination was unremarkable, except for tachycardia of 126 bpm.Throat exam was unremarkable.There was no palpable thyroid goiter or nodules.She had exotropia and right eye pseudo-proptosis with asymmetric superior and inferior eyelid retraction.She had scabbed areas of skin from previous eczema but no other active rash, urticaria or neurocutaneous features.There were no dysmorphic features.Initial workup showed normal cell counts, electrolytes, liver and renal function, vitamin B12, ceruloplasmin, and copper.Infectious workup was negative for HIV, syphilis, and Lyme disease; however, Escherichia coli was detected in her urine.Throat swab was negative for streptococci.An inflammatory workup showed normal C-reactive protein (CRP), an antinuclear antibodies titer of 1:160 (speckled), normal C3 and C4 levels, and negative extractable nuclear antigens panel.Antibodies to thyroid peroxidase, anticardiolipin, B2-glycoprotein, lupus anticoagulant, and double stranded DNA were negative.Thyroid stimulating hormone receptor antibody (TRAb) was elevated at 4.4 IU/L (normal <1.0).Thyroid function
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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".