Supplementary Material for: Lyme Neuroborreliosis Presenting With Isolated Intracranial Hypertension: A Case Report
Bibliographic record
Abstract
Background: Lyme borreliosis (LB), a tick-borne illness caused by Borrelia burgdorferi, is increasingly prevalent in Nova Scotia (NS), Canada, which has the highest incidence in North America. While most cases present as early localized disease, approximately 20% develop early disseminated disease, which can include neurological symptoms, an entity called Lyme neuroborreliosis (LNB). This case report describes an unusual LNB presentation with isolated intracranial hypertension (IH). Case Presentation: A 6-year-old female presented to our pediatric hospital with binocular horizontal diplopia, headache, fever, malaise and suspected papilledema 47 days after an embedded tick bite. A diagnosis of Lyme disease had been made 10 days prior in the community based on positive serologies and erythema migrans, but she developed a Jarisch-Herxheimer reaction within 24h of oral doxycycline, leading to an antibiotic change to amoxicillin. During the hospital admission, an ophthalmological examination revealed papilledema and intracranial hypertension was evidenced by an opening pressure of 36 mmHg and brain MRI findings. The lumbar puncture revealed pleocytosis and positive cerebrospinal fluid antibodies for Borrelia. The patient was initially treated with two days of ceftriaxone, followed by a 12-day outpatient course of doxycycline for LNB. High doses of acetazolamide (500mg TID) were needed to achieve symptom control. Two months after her hospital discharge there was resolution of papilledema and the acetazolamide was weaned. Conclusion: This case highlights the importance of considering Lyme disease in the differential diagnosis of IH, particularly in endemic regions. Early recognition, diagnostic workup, and appropriate treatment are crucial for optimal outcomes in LNB.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.562 | 0.095 |
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".