Objective: To investigate the misdiagnosis of area postrema syndrome (APS) manifesting as intractable nausea, vomiting and hiccups in neuromyelitis optic spectrum disease (NMOSD) and reduce the risk of misdiagnosis. Methods: We retrospectively analyzed data from NMOSD patients attending the Department of Neurology at the First Medical Center of PLA General Hospital between January 2019 and July 2021. SPSS25.0 was then used to analyze the manifestations, misdiagnosis, and mistreatment of APS. Results: A total of 207 patients with NMOSD were included, including 21 males and 186 females. The mean age of onset was 39±15 years (range: 5-72 years). The proportion of patients who were positive for serum aquaporin 4 antibody was 82.6% (171/207). In total, 35.7% (74/207) of the NMOSD patients experienced APS during the disease course; of these patients, 70.3% (52/74) had APS as the first symptom and 29.7% (22/74) had APS as a secondary symptom. The misdiagnosis rates for these conditions were 90.4% (47/52) and 50.0% (11/22), respectively. As the first symptom, 19.2% (10/52) of patients during APS presented only with intractable nausea, vomiting and hiccups; 80.8% (42/52) of patients experienced other neurological symptoms. The Departments of Gastroenterology and General Medicine were the departments that most frequently made the first diagnosis of APS, accounting for 54.1% and 17.6% of patients, respectively. The most common misdiagnoses related to diseases of the digestive system and the median duration of misdiagnosis was 37 days. Conclusions: APS is a common symptom of NMOSD and is associated with a high rate of misdiagnosis. Other concomitant symptoms often occur with APS. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing physical examinations are essential if we are to reduce and avoid misdiagnosis.
Male ; Female ; Humans ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Neuromyelitis Optica/diagnosis* ; Area Postrema ; Retrospective Studies ; Hiccup/complications* ; Vomiting/etiology* ; Nausea/etiology* ; Inflammation ; Syndrome ; Autoantibodies ; Diagnostic Errors ; Aquaporin 4

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.
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

Neuromyelitis optica spectrum disorder (NMOSD) may present with area postrema syndrome, which is characterized by intractable vomiting and hiccups. Hyponatremia is common in NMOSD and is mostly associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). In contrast to SIADH, cerebral salt wasting syndrome (CSWS) causes hyponatremia, which is associated with severe natriuresis and extracellular volume depletion in patients with cerebral disease. To our knowledge, hyponatremia associated with CSWS has not been reported in a patient with NMOSD. Here, we describe a NMOSD presenting with hyponatremia, which may be caused by CSWS following area postrema syndrome.
Area Postrema ; Hiccup ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Natriuresis ; Neuromyelitis Optica* ; Vomiting ; Wasting Syndrome*

We report a 26 year-old female who initially presented with hypersomnia and visual disturbance with preceding upper respiratory infection. She was diagnosed as neuromyelitis optica spectrum disorder (NMOSD) with the presence of anti-AQP4 antibody. Eight months later, she experienced nausea and vomiting refractory to conventional therapies, which was proved correlated with a lesion of area postrema on brain magnetic resonance imaging. These might be significant clinical manifestations in NMOSD and may widen the clinical spectrum of the disease.
Area Postrema ; Brain* ; Disorders of Excessive Somnolence ; Female ; Humans ; Magnetic Resonance Imaging ; Narcolepsy* ; Nausea ; Neuromyelitis Optica* ; Vomiting*

Neuromyelitis optica spectrum disorder (NMOSD) can present with various symptoms including optic neuritis, transverse myelitis, and area postrema syndrome. However, acute memory loss is an uncommon clinical presentation of NMOSD. We report a patient with NMO-IgG-antibody-positive NMOSD presenting with only acute memory loss, which suggested the presence of bilateral thalamic lesions. This case indicates that NMOSD needs to be considered in the differential diagnosis of acute memory loss.
Area Postrema ; Diagnosis, Differential ; Humans ; Memory Disorders* ; Memory* ; Myelitis, Transverse ; Neuromyelitis Optica* ; Optic Neuritis

No abstract available.
Area Postrema ; Neuromyelitis Optica ; Vomiting

BACKGROUNDGingerol is the generic term for pungent constituents in ginger, which has been reported to be effective for inhibiting vomiting. We attempted to investigate the antiemetic effect of gingerol and its effective mechanism on substance P and NK(1) receptors in minks.

METHODSThe antiemetic effect of gingerol was investigated during a 6-hour observation on a vomiting model in minks induced by cisplatin, (7.5 mg/kg, intraperitoneal). The distribution of substance P and NK(1) receptors in the area postrema and ileum were measured by immunohistochemistry, and the expression of NK(1) receptor in the area postrema and ileum were measured by Western blotting.

RESULTSThe frequency of cisplatin induced retching and vomiting was significantly reduced by pretreatment with gingerol in a dose-dependent manner (P < 0.05). Substance P-immunoreactive was mainly situated in the mucosa and submucosa of the ileum as well as in the neurons of the area postrema. The immunoreactive production of NK(1) receptor was mainly situated in the muscular and submucosa of ileum and the neurons of area postrema, gingerol markedly suppressed the increased immunoreactivity of substance P and NK(1)1 receptor induced by cisplatin in a dose-dependent manner (P < 0.05), and exhibited effective inhibition on the increased expression levels of NK(1) receptor in both the ileum and area postrema dose-dependently (P < 0.05).

CONCLUSIONSGingerol has good activity against cisplatin-induced emesis in minks possibly by inhibiting central or peripheral increase of substance P and NK(1) receptors.

Animals ; Area Postrema ; metabolism ; Blotting, Western ; Catechols ; therapeutic use ; Disease Models, Animal ; Fatty Alcohols ; therapeutic use ; Ileum ; metabolism ; Immunohistochemistry ; Male ; Mink ; Receptors, Neurokinin-1 ; metabolism ; Substance P ; metabolism ; Vomiting ; chemically induced ; drug therapy

The brainstem area postrema (AP) has been suggested to be one potential site of lithium's action. In order to determine whether the AP, as a central action site of lithium, is involved in the hypothalamic-pituitary-adrenal (HPA) activation by lithium, we examined lithium-induced expression of inducible cAMP early repressor (ICER) gene in the adrenal gland of rat with lesion of AP. The adrenocortical ICER expression has been suggested to be a marker for the HPA axis activation. Sprague-Dawley rats with lesion or sham lesion of AP received intraperitoneal injection of 0.15 M LiCl at a dose of 12 ml/kg. One hour after the injection, rats were transcardially perfused with fixative and the adrenal glands were processed for ICER mRNA in situ hybridization. ICER mRNA levels in the adrenal cortex of sham lesion rats were significantly increased by lithium, compared to NaCl controls, and this increase was not affected by AP lesion. Our results suggest that the area postrema may not be involved in lithium's action to activate the HPA axis.
Adrenal Cortex ; Adrenal Glands ; Animals ; Area Postrema ; Brain Stem ; In Situ Hybridization ; Injections, Intraperitoneal ; Lithium ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger ; Salicylamides ; Axis, Cervical Vertebra

AIMTo determine the role of area postrema (AP) of rabbit in the regulation of cardiovascular function.

METHODSThe rabbits were anesthetized with intravenous injection of 10% urethane and 1% chloralose, and were artificially ventilated. The changes of mean arterial pressure (MAP) and heart rate (HR) were observed when AP was electrically stimulated with different frequency (10 Hz -80 Hz) and after chemical lesion of CVLM or RVLM, respectively.

RESULTSElectrical stimulation of AP with low frequency (10 Hz, 20 Hz) decreased MAP and HR. Stimulation with high frequency(60 Hz, 80 Hz) increased MAP but decreased HR. The changes in MAP and HR were significantly lower (P < 0.01) after CVLM was destroyed when electrical stimulation of AP with 20 Hz, and both changes of MAP and HR were disappeared (P < 0.01) after RVLM was destroyed when electrical stimulation with 20 and 80 Hz.

CONCLUSIONElectrical stimulation of AP with low frequency decreases MAP and HR, stimulation with high frequency induces an increase in MAP and decreases in HR. The former is probably related to excitation of CVLM, the cardiovascular effects induced by different frequency of electrical stimulation are all resulted from the activation of RVLM.

Animals ; Area Postrema ; physiology ; radiation effects ; Blood Pressure ; radiation effects ; Electric Stimulation ; Heart Rate ; radiation effects ; Male ; Medulla Oblongata ; physiology ; radiation effects ; Rabbits

OBJECTIVETo explore the role of area postrema (AP) of medulla in control of cardiovascular functions in rat.

METHODS(1) Sprague Dawley rats were anaesthetized with urethane and pentobarbital and the AP was stimulated by electrical stimulus with intensity of 0.1 mA and frequencies ranged 10 approximate, equals 80 Hz. (2) Excitatory amino acid L-glutamate (L- Glu, 0.1 approximate, equals 0.5 mol/L) was microinjected into AP in urethane anaesthetized rats and the changes of mean arterial pressure (MAP) and heart rate (HR) were recorded.

RESULT(1) When the frequencies of 10 Hz, 20 Hz and 40 Hz were used, the electrical stimulation of AP caused decrease of MAP and HR (P<0.001),while the electrical stimulation with the frequencies of 60 Hz and 80 Hz caused an increase of MAP (P<0.05) but a decrease of HR (P<0.001). (2) Microinjection of L-Glu at 0.1 mol/L had no effect on MAP and HR (P>0.05), but it decreased MAP and HR at 0.15 mol/L (P<0.001, P<0.05). The MAP was increased (P<0.001) but HR (P<0.05) was decreased at the concentrations of 0.2 mol/L and 0.5 mol/L, respectively.

CONCLUSIONAlterations of MAP and HR induced by electrical or chemical stimulation on AP of medulla are related to the frequency of electrical stimulation or concentration of L-Glu.

Animals ; Area Postrema ; physiology ; Blood Pressure ; drug effects ; Electric Stimulation ; Glutamic Acid ; pharmacology ; Heart Rate ; drug effects ; Male ; Rats ; Rats, Sprague-Dawley ; Solitary Nucleus ; physiology