Academic literature on the topic 'Float switch sensors'

A 16-year-old girl was evaluated for symptoms of thoracic myelitis with sensory loss below T12, gait difficulty, constipation, and incomplete bladder emptying. On evaluation, she had a flat affect, normal cranial nerve function, and normal motor examination findings. Deep tendon reflexes were symmetric, and plantar responses were flexor. She had a sensory level at T12 with diminished vibratory sense distal to the knees and normal coordination and gait. Magnetic resonance imaging of the brain, cervical spine, and thoracic spine showed a high burden of disease, with multiple enhancing lesions indicative of highly active disease. Spinal fluid analysis showed 16 white blood cells/µL with 95% lymphocytes; protein, 70 mg/dL; 7 unique oligoclonal bands; and immunoglobulin G index, 0.87. Neurocognitive testing showed normal scores overall, and psychiatric evaluation indicated major depressive disorder. She was given a diagnosis of relapsing-remitting multiple sclerosis, highly active. On initial evaluation for thoracic myelitis, intravenous methylprednisolone was given, with resolution of bladder and bowel symptoms and 75% recovery of sensory loss. High-dose interferon beta-1a was then initiated. At age 28 years, she had worsening left hemiparesis of 1 month’s duration. Neurologic examination showed word-finding difficulty, gaze-evoked horizontal nystagmus, moderate left-sided spastic hemiparesis in a pyramidal distribution, brisk reflexes with an extensor plantar response on the left, sensory ataxia in the left leg, and a hemiparetic gait. Intravenous methylprednisolone was given, with minimal improvement. She then received plasmapheresis with about 50% recovery of power. The patient was seropositive for antibodies to JC polyoma virus. Despite the increased risk of progressive multifocal leukoencephalopathy, natalizumab was reinitiated considering the even higher risk of long-term disability due to continued active disease (highly active multiple sclerosis). Her therapy was transitioned to teriflunomide. Six months later she returned with new right leg weakness and received high-dose intravenous corticosteroids for 5 days, followed by rituximab infusion. On follow-up neuroimaging, breakthrough disease activity was noted, and her therapy was switched to alemtuzumab. Highly active multiple sclerosis is characterized by frequent clinical episodes, with or without high disease activity on neuroimaging as evidenced by multiple enhancing lesions or interval new lesion formation, and disability accrual. It includes a spectrum of patients with clinical and radiologic evidence of ongoing disease activity who have no response to adequate treatment with multiple sclerosis disease-modifying therapy.