Neuromyelitis Optica Spectrum Disorder Presented with Upbeat Nystagmus and Intractable Vomiting
10.21790/rvs.2019.18.2.50
- Author:
Hyunsoo KIM
1
;
Jae Myung KIM
;
Tai Seung NAM
;
Seung Han LEE
Author Information
1. Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea. nrshlee@chonnam.ac.kr
- Publication Type:Case Report
- Keywords:
Area postrema;
Neuromyelitis optica spectrum disorder;
Vomiting;
Vertical nystagmus
- MeSH:
Adult;
Area Postrema;
Autoimmune Diseases;
Brain;
Central Nervous System;
Diagnosis;
Dizziness;
Female;
Hiccup;
Humans;
Magnetic Resonance Imaging;
Myelitis, Transverse;
Nausea;
Neuromyelitis Optica;
Nystagmus, Pathologic;
Optic Nerve;
Recurrence;
Spinal Cord;
Vomiting
- From:Journal of the Korean Balance Society
2019;18(2):50-53
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating autoimmune disease of central nervous system characterized by relapsing attacks that target the optic nerves and spinal cord, as well as aquaporin-4 (AQP4) enriched periventricular brain regions. The area postrema (AP), located in the dorsal medulla, is the chemosensitive vomiting center and has high AQP-4 expression. The AP syndrome with unexplained hiccups, nausea, and vomiting is one of the core clinical characteristics in the NMOSD and maybe the first presenting symptom. We experienced a 25-year-old woman presented with intractable vomiting, dizziness and oscillopsia. Upbeat nystagmus detected on the bedside examination led to comprehensive neurological workups including magnetic resonance imaging, and she was diagnosed as the AP syndrome. Ten months later, she experienced a recurrence as a longitudinally extensive transverse myelitis and the diagnosis was finally compatible with NMOSD without AQP4-IgG. NMOSD, especially the AP syndrome, should be considered in any dizzy patient with intractable vomiting, and detailed neuro-otologic and neuro-ophthalmologic examinations are warranted for the correct diagnosis.
