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Induction of Paralysis and Visual System Injury in Mice by T Cells Specific for Neuromyelitis Optica Autoantigen Aquaporin-4
Published on: August 21, 2017
Intractable vomiting as the initial presentation of neuromyelitis optica.
Metha Apiwattanakul1, Bogdan F Popescu, Marcelo Matiello
1Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Annals of Neurology
|October 30, 2010
Summary
Intractable vomiting can be an early symptom of neuromyelitis optica, particularly in aquaporin-4 antibody-positive individuals. This initial gastrointestinal presentation may precede neurological symptoms like optic neuritis or transverse myelitis.
Area of Science:
- Neurology
- Immunology
- Gastroenterology
Background:
- Neuromyelitis optica (NMO) is an autoimmune disorder targeting the central nervous system.
- Aquaporin-4 antibodies are key biomarkers for NMO spectrum disorders.
- NMO often presents with optic neuritis and transverse myelitis, but atypical presentations exist.
Purpose of the Study:
- To investigate the role of the area postrema in the initial presentation of NMO.
- To identify patients with NMO whose first symptom was intractable vomiting.
Main Methods:
- Retrospective review of aquaporin-4 antibody-positive patients at Mayo Clinic since 2005.
- Analysis of presenting symptoms, duration of symptoms, and subsequent development of neurological deficits.
- Clinical, pathological, and neuroimaging data review.
Main Results:
- Twelve patients (12% of seropositive cases) presented initially with intractable vomiting.
- Gastroenterologic evaluation was the initial approach in 75% of these patients.
- Optic neuritis or transverse myelitis developed in 11 patients after a median of 11 weeks.
- Seven patients met NMO diagnostic criteria by the last evaluation.
Conclusions:
- The area postrema, rich in aquaporin-4, may be an initial target in NMO.
- Intractable vomiting can be a critical early sign of NMO, necessitating consideration of autoimmune etiologies.
- Early recognition of atypical presentations can improve NMO patient outcomes.
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