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Research in Vestibular Science > Accepted Articles
Neuromyelitis Optica Spectrum Disorder presented with Upbeat Nystagmus and Intractable Vomiting
Hyunsoo Kim1, Jae-Myung Kim1, Tai-Seung Nam1, Seung-Han Lee1
1Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
2Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
Correspondence  Seung-Han Lee ,Tel: 062-220-6274, Fax: 062-228-3461, Email: nrshlee@chonnam.ac.kr
Received: May 20, 2019;  Accepted: June 10, 2019.  Published online: June 10, 2019.
Neuromyelitis optica spectrum disorder(NMOSD) is an inflammatory demyelinating autoimmune disease of CNS 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 MRI, and she was diagnosed as the AP syndrome. Ten months later, she experienced a recurrence as a longitudinal 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.
Keywords: Area postrema; Neuromyelitis optica spectrum disorder; Vomiting; Vertical nystagmus
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Related article
Neuromyelitis Optica Spectrum Disorder Presented with Upbeat Nystagmus and Intractable Vomiting  2019 June;18(2)
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