Cauda equina nerve root enhancement in adult intestinal toxemia botulism
Bibliographic record
Abstract
BACKGROUND: Adult botulism is a rare, life-threatening condition typically caused by exposure to preformed botulinum neurotoxin (BoNT). Acute intestinal toxemia botulism (AITB) is an uncommon subtype resulting from colonization of Clostridium botulinum in the intestines. Diagnosis is made by detecting BoNT in the patient's blood, stool, or gastric fluid. AITB is confirmed when C. botulinum is isolated in culture. Electrodiagnostic studies may support the diagnosis, while imaging-when performed-is generally used to exclude alternative conditions. CASE PRESENTATION: A 74-year-old man presented with acute dysarthria and ophthalmoparesis, which rapidly progressed to quadriparesis and respiratory failure requiring intubation. Magnetic resonance imaging (MRI) revealed thickening and enhancement of the cauda equina nerve roots. Due to high clinical suspicion for botulism, heptavalent botulinum antitoxin was administered. Intravenous immunoglobulin was also given, as the imaging findings raised concern for an alternative diagnosis of Guillain-Barré syndrome (GBS). Blood and stool samples later tested positive for BoNT type A, and C. botulinum was isolated from the stool, confirming AITB. The patient experienced a gradual but prolonged recovery of motor function following treatment. CONCLUSIONS: Botulism in both infants and adults is not typically associated with abnormal neuroimaging findings. To our knowledge, this is the first reported case of cauda equina nerve root thickening and enhancement on MRI in AITB-or in adult botulism more broadly. We outline the differential diagnosis, pathophysiology, and treatment of botulism. This case underscores that abnormal neuroimaging should not delay prompt empiric treatment for botulism when clinical suspicion is high.
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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 | 0.001 |
| 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 | 0.001 |
| 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".