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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
Neuromyelitis optica unique area postrema lesions: nausea, vomiting, and pathogenic implications
B F Gh Popescu1, V A Lennon, J E Parisi
1Mayo Clinic, College of Medicine, Rochester, MN 55905, USA.
Neurology
|March 4, 2011
Summary
Neuromyelitis optica (NMO) lesions in the area postrema cause severe nausea and vomiting. This neuropathologic study found specific brainstem changes linked to these debilitating symptoms in NMO patients.
Area of Science:
- Neuropathology
- Neuroimmunology
- Gastroenterology
Background:
- Neuromyelitis optica (NMO) is an autoimmune disease targeting the central nervous system.
- Aquaporin-4 (AQP4) autoimmunity is implicated in NMO pathogenesis.
- Intractable nausea and vomiting are common, debilitating symptoms in NMO patients.
Purpose of the Study:
- To investigate the neuropathologic characteristics of NMO lesions in the medullary floor of the fourth ventricle and area postrema.
- To determine the association between lesions in this region and the occurrence of nausea/vomiting in NMO.
Main Methods:
- Archival brainstem tissue from 15 NMO patients, 5 MS patients, and 8 controls were analyzed neuropathologically.
- Lesion presence in the area postrema and medullary floor was assessed.
- Logistic regression evaluated the correlation between these lesions and documented nausea/vomiting.
Main Results:
- Six NMO patients (40%) exhibited lesions in the area postrema/medullary floor, absent in MS and control groups.
- Lesions showed tissue rarefaction, vascular thickening, preserved myelin, and loss of AQP4 immunoreactivity.
- NMO cases with these lesions had a 16-fold increased odds of experiencing nausea/vomiting.
Conclusions:
- The area postrema appears to be a selective target in NMO neuropathology.
- These findings support the area postrema's role in NMO-associated nausea and vomiting.
- Symptoms like nausea/vomiting may precede or herald NMO onset.
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