A 27-year-old female with no medical history was referred to the internal medicine department for intractable nausea, vomiting, and hiccup. Symptoms had started 1 month prior to her visit, and she had since lost 13 kg of body weight. She complained of headaches, photophobia, and mild epigastric pain.
Assessment
She was afebrile, and the physical examination was unremarkable, with a normal abdominal and neurological examination including the absence of neck stiffness. Nausea and vomiting were refractory to the association of metoclopramide, ondansetron, and alizapride. There was no history of cannabis consumption. Standard laboratory tests were within the range of normal values, including negative β-HCG assay and unremarkable cerebrospinal fluid. Abdominal and cerebral computerized tomography scan and gastroscopy were normal.
Diagnosis
Cerebral magnetic resonance imaging (MRI) revealed a T2-weighted (axial fluid-attenuated inversion recovery [FLAIR]) hyperintensity in the area postrema (Figure, white arrow). The ophthalmologic examination and the MRI imaging of the spinal cord and optic nerves were normal. Anti-aquaporin 4 autoantibodies (AQP4) were positive in the serum consistent with the diagnosis of neuromyelitis optica spectrum disorder with isolated area postrema syndrome.
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-Thomas Frapard, MDa, Zahir Amoura, MD, MSca, Marc Pineton de Chambrun, MD, MSca,b,
