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Multiple sclerosis with intractable vomiting and atypical area postrema lesion
Yeow Hoay Koh1, Pavanni Ratnagopal2
1Singapore General Hospital, Neurology Department, 20 College Road, 169856, Singapore.
Multiple Sclerosis and Related Disorders
|July 6, 2020
Summary
Area postrema syndrome, typically seen in neuromyelitis optica spectrum disorders, can also occur in multiple sclerosis. This case highlights the need for clinical context in diagnosing these conditions.
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Area postrema syndrome is a hallmark of neuromyelitis optica spectrum disorders (NMOSDs).
- Area postrema involvement is uncommon in multiple sclerosis (MS).
Observation:
- A 36-year-old woman with a history of MS presented with intractable vomiting.
- Brain MRI revealed an area postrema lesion with contrast enhancement.
- Serum antibodies for AQP4 and MOG were negative.
Findings:
- The patient's symptoms resolved with methylprednisolone and she achieved remission on interferon-beta 1a.
- This case demonstrates area postrema lesion presentation in MS.
- Diagnostic criteria for MS and NMOSDs require careful clinical correlation.
Implications:
- Area postrema lesions are not exclusive to NMOSDs and can be seen in MS.
- Relying solely on MRI findings can lead to misdiagnosis between MS and NMOSDs.
- Clinical context is crucial for accurate diagnosis and management of CNS inflammatory disorders.
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