[A case of neuromyelitis optica spectrum disorder presenting with severe orthostatic hypotension]

The patient is a 68-year-old Japanese woman. She was admitted to our hospital due to continuous hiccups and vomiting episodes for more than one week. On examinations, muscle strength in her right lower limb was slightly decreased, and pyramidal tract signs were positive bilaterally. The fluid attenuated inversion recovery imaging of the brain showed lesions in the dorsal and lateral medulla. Serum anti-aquaporin 4 antibody was positive. We then diagnosed the patient with neuromyelitis optica spectrum disorder (NMOSD). Severe orthostatic hypotension (OH) was determined. While hiccups and vomiting improved gradually, OH lasted for more than three weeks. OH improved after administration of intravenous methylpredonisolone-pulse therapy. In this case, the lesion in the dorsal medulla might be responsible for OH. We considered that OH might be one of the symptoms of NMOSD.