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HOME > J Korean Bal Soc > Accepted Articles > Article
5 Neuromyelitis Optica Spectrum Disorder presented with Upbeat Nystagmus and Intractable Vomiting
Hyunsoo Kim1, Jae-Myung Kim1, Tai-Seung Nam1, Seung-Han Lee1

DOI: https://doi.org/ [Accepted]
Published online: June 10, 2019
1Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
2Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
Corresponding author:  Seung-Han Lee, Tel: 062-220-6274, Fax: 062-228-3461, 
Email: nrshlee@chonnam.ac.kr
Received: 20 May 2019   • Accepted: 10 June 2019
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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.


Res Vestib Sci : Research in Vestibular Science