Isolated Area Postrema Syndrome Presenting as Intractable Nausea and Vomiting

Area of Science:

• Neuroimmunology
• Neurology

Background:

• Neuromyelitis optica (NMO) and NMO spectrum disorders (NMOSD) are central nervous system inflammatory diseases.
• Demyelination and axonal damage primarily affect the optic nerves and spinal cord.
• Brainstem involvement, including the area postrema (AP), can cause symptoms like nausea and vomiting.

Observation:

• The 2015 International Panel for NMO Diagnosis criteria unified NMO and related disorders under NMOSD.
• Area Postrema Syndrome (APS) is a diagnostic category within NMOSD for patients with AP involvement.
• Typically, patients with APS also exhibit other neurological symptoms.

Findings:

• This report details a rare case of NMO presenting with isolated APS.
• The patient experienced only nausea and vomiting, with no concurrent optic neuritis or myelitis.
• This presentation challenges the typical association of APS with other neurological deficits in NMOSD.

Implications:

• Highlights the diagnostic variability of NMOSD.
• Suggests isolated APS can be an initial presentation of NMOSD.
• Emphasizes the need to consider NMOSD in patients with unexplained APS, even without other neurological symptoms.