Methylprednisolone was given from 1000 mg/day, and halved every three days until 40 mg/day then, the methylprednisolone was changed to oral, and reduced one tablet every 15 days. After admission, the patient was given 2 g/kg of Human Immunoglobulin (PH4) (5 times) and steroids pulse. Spot-like gadolinium enhancement was found in lesions. Spinal MRI showed lesions in the medulla oblongata, C2-T1, T4, T7, T11-12, and spinal conus (Fig. A little gadolinium enhancement was found in some lesions (Fig. There were lesions in the bilateral frontal, apical, temporal, occipital cerebral gyrus, bilateral insular, right brachium pontis, medulla, and corpus callosum. The review of Brain MRI (1.5T) showed that the lesions were significantly increased compared with that before 15 days. But the MOG antibody IgG was positive in serum (both RIA and CBA method positive). The AQP-4 antibody was negative in serum and cerebrospinal fluid. After the disease aggravated, we reviewed a cerebrospinal fluid examination and showed a pressure of 360 mm H2O, protein concentration of 0.53 g/L, pleocytosis of 164×10 6/L (multinuclear 0.02, mononuclear 0.98), normal concentration of glucose and chloride, immunoglobulin G of 39.3 mg/L, and negative oligoclonal band. Fundus examination showed binocular optic neuropathy. The patient gradually appeared dizziness, emotional irritability, urinary incontinence, binocular vision loss only light sense, disorder of binocular movement, spontaneous rotatory nystagmus, dysarthria, dysphagia, grade 4 of the left upper limb on Muscle Strength Grading Scale, grade 3 of the right upper limb on Muscle Strength Grading Scale, grade 1 of lower limbs on Muscle Strength Grading Scale, low muscle tension, tendon jerk weakened, the sensory of pain reduction below L2, unstable left finger nose test, positive Babinski’s sign in left, neutral Babinski sign in right, no stiff-neck, and negative Kernig sign. Within 15 days of admission, the condition continued to progress. 24-hour EEG showed non-specific slow wave in the frontal area. Brain MRI (1.5T) found the T1 hypointense, T2 and Flair hyperintense lesion in right brachium pontis (Fig. The analysis of ANA, dsDNA Ab, ANCA, APL, erythrocyte sedimentation rate, C-reactive protein, thyroid function, tumor markers, HIV, syphilis, and hepatitis B virus were all normal. After admission, the first cerebrospinal fluid (CSF) examination showed a pressure of 300 mm H2O, colorless and transparent cerebrospinal fluid, pleocytosis of 249×10 6/L (multinuclear cell 0.1, mononuclear cell 0.9), normal concentration of protein, glucose, and chloride. At the time of admission, neurological examination revealed clear consciousness and speech, normal cranial nerve, grade 5 of limbs muscle strength on Muscle Strength Grading Scale, normal sense, unstable left finger-nose test and heel-knee-shin test, positive Babinski’s sign in left, suspiciously positive stiff-neck, and negative Kernig sign. Save as PDF, musicXML, or MIDI.A 15-year-old boy was admitted to our hospital because of a headache for 2 weeks, episodes of convulsions with fever for 3 days. Choose standard sheet music or guitar tablature. Pick from a variety of different instruments to auto-format sheet music in the correct key, range, and staff. Slow down the playback without changing the pitch.Ĭustomize for your instrument. AnthemScore provides a visual representation of the audio spectrum based on a dynamic Q transform so you can use feedback from both senses. Advanced editing options make it fast to tweak any transcription. Change the time signature, key signature, or tempo for any measure in the song.
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