Acute Horner syndrome from supraclavicular lymphadenopathy as the first manifestation of metastatic lung carcinoma
Bibliographic record
Abstract
Introduction Horner syndrome is a rare ocular condition consisting of pupil miosis, eyelid ptosis and facial anhidrosis. It occurs secondary to damage along the three-neuron sympathetic nerve pathway that travels a long course from the brain to the eye. If acute, the syndrome can be the presenting sign of life-threatening pathology in the head, chest, or neck. Thorough history, careful clinical exam, and proper imaging studies are essential to diagnose the syndrome, help localize the lesion and determine proper treatment for the underlying etiology. Case Report This case presents a 62-year-old female patient with an acute left-sided Horner syndrome confirmed by pharmacologic testing. She had an unremarkable medical history beyond arthritis, denied a history of trauma, and reported a tobacco smoking history. Further review of symptoms did not allow for definitive localization of the lesion, nor did she have a known underlying cause of Horner syndrome at presentation. Emergent imaging of the chest and neck revealed a preganglionic lesion caused by metastatic supraclavicular lymphadenopathy in the neck originating from primary lung carcinoma. Brain magnetic resonance imaging identified several areas of metastasis to the brain. She was treated with prompt chemotherapy and radiation. Conclusion An adult patient with acute Horner syndrome without significant localizing symptoms or pertinent review of systems requires an emergent and thorough work up to rule out malignancy. Horner syndrome as the first presenting sign of undetected malignancy along the sympathetic chain is rare. An accurate diagnosis from an optometrist and subsequent timely referral is critical to uncover potentially life-threatening pathology that may be unknown to the patient at the time of presentation.
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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 | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.014 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.003 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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; both teacher heads agree on what is shown here.
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".