c00cjz00/phi-4-14b-it-R1-m22k

Use model

Vllm inference

• start server

vllm serve c00cjz00/phi-4-14b-it-R1-m22k \
  --trust-remote-code \
  --served-model-name c00cjz00/phi-4-14b-it-R1-m22k \
  --tensor-parallel-size 1 \
  --dtype auto \
  --port 8000 \
  --max-model-len 16384 \
  --max-seq-len-to-capture 16384 \
  --gpu-memory-utilization 0.97 \
  --swap-space 32 \
  --enforce-eager \
  --api-key sk1234

Chat completion (1)

Thinking On

• Query

curl -X POST "http://localhost:8000/v1/chat/completions" \
-H "Authorization: Bearer sk1234" -H "Content-Type: application/json" \
-d '{ "model": "c00cjz00/phi-4-14b-it-offon-R1-m22k", "messages": [{"role": "user", "content": "A 45-year-old man with a history of alcohol use, who has been abstinent for the past 10 years, presents with sudden onset dysarthria, shuffling gait, and intention tremors. Given this clinical presentation and history, what is the most likely diagnosis?"}], "temperature": 0.6}'

• Output

{"id":"chatcmpl-f0ca5f1bbf01410894c10ae9a2d3e09b","object":"chat.completion","created":1742586110,"model":"c00cjz00/phi-4-14b-it-offon-R1-m22k","choices":[{"index":0,"message":{"role":"assistant","reasoning_content":null,"content":"<think>Okay, let's tackle this problem step by step. The patient is a 45-year-old man with a history of alcohol use but has been abstinent for 10 years. He's now presenting with sudden onset dysarthria, shuffling gait, and intention tremors. The question is asking for the most likely diagnosis.\n\nFirst, I need to recall the possible causes of these symptoms. Dysarthria can be due to neurological issues affecting speech muscles. A shuffling gait is often seen in Parkinson's disease, where there's a problem with movement initiation. Intention tremors, which get worse with movement, are typically associated with cerebellar issues.\n\nThe patient's history of alcohol use is important here. Chronic alcohol abuse can lead to several neurological problems. One key condition to consider is Wernicke-Korsakoff syndrome, which is caused by thiamine (vitamin B1) deficiency. However, this usually presents with symptoms like confusion, ataxia, and nystagmus, and it's often acute. Since he's been abstinent for 10 years, it's possible he might have developed a chronic form, but the sudden onset is a bit puzzling unless there's a recent relapse or another issue.\n\nAnother possibility is Alcoholic Cerebellar Degeneration (ACD). This condition arises from long-term alcohol abuse leading to cerebellar atrophy. The cerebellum is responsible for coordination, so damage here would explain the intention tremors and shuffling gait. The dysarthria could also be due to cerebellar involvement, as the cerebellum helps coordinate speech muscles.\n\nNow, considering the timeline: he's been abstinent for a decade. Chronic alcoholism can lead to long-term brain damage even after stopping drinking. The cerebellum is particularly vulnerable to alcohol's neurotoxic effects. So, even after 10 years, residual damage could manifest as ACD.\n\nOther differentials to consider: Multiple Sclerosis (MS) can cause intention tremors and ataxia, but it's less likely given the history. Parkinson's disease is possible, but the tremors in Parkinson's are resting tremors, not intention tremors. Also, Parkinson's usually has a more gradual onset, whereas this is sudden.\n\nAnother angle: could it be a vitamin deficiency now, like B12? But again, the history points more towards alcohol-related damage. Also, B12 deficiency would more likely cause peripheral neuropathy or subacute combined degeneration, which might present differently.\n\nSo putting it all together: the combination of cerebellar symptoms (intention tremor, ataxia) and the history of alcohol use points strongly to Alcoholic Cerebellar Degeneration. The sudden onset might be due to the culmination of slow progressive damage that's now clinically apparent, even though he's been abstinent. The dysarthria fits with cerebellar involvement in speech.\n\nI should also think about other causes of cerebellar atrophy, but the key here is the history. Since he's been abstinent, it's less likely to be acute Wernicke's, and more likely chronic damage from past alcohol use.\n\nTherefore, the most likely diagnosis is Alcoholic Cerebellar Degeneration.</think>\n\nThe most likely diagnosis is **Alcoholic Cerebellar Degeneration (ACD)**, supported by the following analysis:\n\n### **Generating Initial Hypotheses**\n1. **Alcoholic Cerebellar Degeneration (ACD)**: Chronic alcohol use causes cerebellar atrophy, leading to ataxia, intention tremors, and dysarthria.\n2. **Wernicke-Korsakoff Syndrome**: Thiamine deficiency from alcoholism causes acute/subacute encephalopathy, but the patient’s 10-year abstinence reduces likelihood of active deficiency.\n3. **Parkinson’s Disease**: Resting tremor and bradykinesia are typical, but intention tremors and shuffling gait are less characteristic.\n4. **Multiple Sclerosis (MS)**: Can cause cerebellar symptoms, but lacks the alcohol-use history as a primary etiology.\n5. **Vitamin Deficiencies (e.g., B12)**: May cause neuropathy or subacute combined degeneration but are less likely given the alcohol history.\n\n---\n\n### **Testing Hypotheses and Gathering Further Information**\n- **Clinical Correlation**:\n  - **ACD**: Cerebellar symptoms (intention tremors, ataxia, dysarthria) align with cerebellar atrophy secondary to chronic alcohol use.\n  - **Wernicke-Korsakoff**: Acute presentation with confusion/nystagmus is inconsistent with the absence of recent alcohol use.\n  - **Parkinson’s**: Resting tremor and gradual onset are inconsistent with the patient’s presentation.\n- **Imaging**: MRI would show cerebellar atrophy in ACD, while MS might show demyelinating lesions, and Parkinson’s would not explain cerebellar symptoms.\n\n---\n\n### **Exploring Alternative Diagnoses**\n- **Spinocerebellar Ataxia**: Genetic causes may mimic ACD but lack the alcohol-use history.\n- **Toxic Exposure**: Unlikely without history of other toxins.\n- **Vascular Events**: Less likely given the absence of focal neurological deficits (e.g., hemiparesis, aphasia).\n\n---\n\n### **Evaluating Options**\n- **ACD** is the most consistent diagnosis due to:\n  - **History**: Chronic alcohol use is a well-established risk factor for cerebellar degeneration.\n  - **Symptoms**: Intention tremors and ataxia are hallmark features of cerebellar dysfunction.\n  - **Timing**: Even after 10 years of abstinence, cumulative neurotoxic effects can manifest as delayed cerebellar atrophy.\n\n---\n\n### **Final Diagnosis**\n**Alcoholic Cerebellar Degeneration (ACD)** is the most likely diagnosis. The patient’s history of alcohol use, even with 10 years of abstinence, supports chronic cerebellar damage. The sudden onset of symptoms may reflect the culmination of progressive atrophy rather than acute toxicity. Further evaluation with MRI and vitamin level testing (e.g., B12, thiamine) can confirm the diagnosis and rule out other causes.","tool_calls":[]},"logprobs":null,"finish_reason":"stop","stop_reason":null}],"usage":{"prompt_tokens":72,"total_tokens":1371,"completion_tokens":1299,"prompt_tokens_details":null},"prompt_logprobs":null}

<think>
Okay, let's tackle this problem step by step. The patient is a 45-year-old man with a history of alcohol use but has been abstinent for 10 years. He's now presenting with sudden onset dysarthria, shuffling gait, and intention tremors. The question is asking for the most likely diagnosis.
First, I need to recall the possible causes of these symptoms. Dysarthria can be due to neurological issues affecting speech muscles. A shuffling gait is often seen in Parkinson's disease, where there's a problem with movement initiation. Intention tremors, which get worse with movement, are typically associated with cerebellar issues.
The patient's history of alcohol use is important here. Chronic alcohol abuse can lead to several neurological problems. One key condition to consider is Wernicke-Korsakoff syndrome, which is caused by thiamine (vitamin B1) deficiency. However, this usually presents with symptoms like confusion, ataxia, and nystagmus, and it's often acute. Since he's been abstinent for 10 years, it's possible he might have developed a chronic form, but the sudden onset is a bit puzzling unless there's a recent relapse or another issue.
Another possibility is Alcoholic Cerebellar Degeneration (ACD). This condition arises from long-term alcohol abuse leading to cerebellar atrophy. The cerebellum is responsible for coordination, so damage here would explain the intention tremors and shuffling gait. The dysarthria could also be due to cerebellar involvement, as the cerebellum helps coordinate speech muscles.
Now, considering the timeline: he's been abstinent for a decade. Chronic alcoholism can lead to long-term brain damage even after stopping drinking. The cerebellum is particularly vulnerable to alcohol's neurotoxic effects. So, even after 10 years, residual damage could manifest as ACD.
Other differentials to consider: Multiple Sclerosis (MS) can cause intention tremors and ataxia, but it's less likely given the history. Parkinson's disease is possible, but the tremors in Parkinson's are resting tremors, not intention tremors. Also, Parkinson's usually has a more gradual onset, whereas this is sudden.
Another angle: could it be a vitamin deficiency now, like B12? But again, the history points more towards alcohol-related damage. Also, B12 deficiency would more likely cause peripheral neuropathy or subacute combined degeneration, which might present differently.
So putting it all together: the combination of cerebellar symptoms (intention tremor, ataxia) and the history of alcohol use points strongly to Alcoholic Cerebellar Degeneration. The sudden onset might be due to the culmination of slow progressive damage that's now clinically apparent, even though he's been abstinent. The dysarthria fits with cerebellar involvement in speech.
I should also think about other causes of cerebellar atrophy, but the key here is the history. Since he's been abstinent, it's less likely to be acute Wernicke's, and more likely chronic damage from past alcohol use.
Therefore, the most likely diagnosis is Alcoholic Cerebellar Degeneration.</think>
The most likely diagnosis is **Alcoholic Cerebellar Degeneration (ACD)**, supported by the following analysis:

### **Generating Initial Hypotheses**
1. **Alcoholic Cerebellar Degeneration (ACD)**: Chronic alcohol use causes cerebellar atrophy, leading to ataxia, intention tremors, and dysarthria.
2. **Wernicke-Korsakoff Syndrome**: Thiamine deficiency from alcoholism causes acute/subacute encephalopathy, but the patient’s 10-year abstinence reduces likelihood of active deficiency.
3. **Parkinson’s Disease**: Resting tremor and bradykinesia are typical, but intention tremors and shuffling gait are less characteristic.
4. **Multiple Sclerosis (MS)**: Can cause cerebellar symptoms, but lacks the alcohol-use history as a primary etiology.
5. **Vitamin Deficiencies (e.g., B12)**: May cause neuropathy or subacute combined degeneration but are less likely given the alcohol history.

### **Testing Hypotheses and Gathering Further Information**
- **Clinical Correlation**:
  - **ACD**: Cerebellar symptoms (intention tremors, ataxia, dysarthria) align with cerebellar atrophy secondary to chronic alcohol use.
  - **Wernicke-Korsakoff**: Acute presentation with confusion/nystagmus is inconsistent with the absence of recent alcohol use.
  - **Parkinson’s**: Resting tremor and gradual onset are inconsistent with the patient’s presentation.
- **Imaging**: MRI would show cerebellar atrophy in ACD, while MS might show demyelinating lesions, and Parkinson’s would not explain cerebellar symptoms.

### **Exploring Alternative Diagnoses**
- **Spinocerebellar Ataxia**: Genetic causes may mimic ACD but lack the alcohol-use history.
- **Toxic Exposure**: Unlikely without history of other toxins.
- **Vascular Events**: Less likely given the absence of focal neurological deficits (e.g., hemiparesis, aphasia).

### **Evaluating Options**
- **ACD** is the most consistent diagnosis due to:
  - **History**: Chronic alcohol use is a well-established risk factor for cerebellar degeneration.
  - **Symptoms**: Intention tremors and ataxia are hallmark features of cerebellar dysfunction.
  - **Timing**: Even after 10 years of abstinence, cumulative neurotoxic effects can manifest as delayed cerebellar atrophy.

### **Final Diagnosis**
**Alcoholic Cerebellar Degeneration (ACD)** is the most likely diagnosis. The patient’s history of alcohol use, even with 10 years of abstinence, supports chronic cerebellar damage. The sudden onset of symptoms may reflect the culmination of progressive atrophy rather than acute toxicity. Further evaluation with MRI and vitamin level testing (e.g., B12, thiamine) can confirm the diagnosis and rule out other causes."