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Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report

OBJECTIVE: We report a case of biopsy-proven giant cell arteritis after an initial presentation of area postrema syndrome. METHODS: A 65-year-old man was evaluated using MRI, temporal artery biopsy, and ultrasound. RESULTS: The patient presented with refractory nausea, vomiting, and hiccups that cau...

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Autores principales: da Silva, Matheus Alves, de Carvalho, Barbara Maini, de Queiroz, André Luiz Guimarães, Lima, Karlla Danielle Ferreira, Teixeira, Hennan Salzedas, Schmid, Marcelo Freitas, Campos, Christiane Monteiro de Siqueira, Baeta, Alex Machado
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136673/
https://www.ncbi.nlm.nih.gov/pubmed/37185110
http://dx.doi.org/10.1212/NXI.0000000000200113
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author da Silva, Matheus Alves
de Carvalho, Barbara Maini
de Queiroz, André Luiz Guimarães
Lima, Karlla Danielle Ferreira
Teixeira, Hennan Salzedas
Schmid, Marcelo Freitas
Campos, Christiane Monteiro de Siqueira
Baeta, Alex Machado
author_facet da Silva, Matheus Alves
de Carvalho, Barbara Maini
de Queiroz, André Luiz Guimarães
Lima, Karlla Danielle Ferreira
Teixeira, Hennan Salzedas
Schmid, Marcelo Freitas
Campos, Christiane Monteiro de Siqueira
Baeta, Alex Machado
author_sort da Silva, Matheus Alves
collection PubMed
description OBJECTIVE: We report a case of biopsy-proven giant cell arteritis after an initial presentation of area postrema syndrome. METHODS: A 65-year-old man was evaluated using MRI, temporal artery biopsy, and ultrasound. RESULTS: The patient presented with refractory nausea, vomiting, and hiccups that caused weight loss without any other neurologic or clinical symptoms. His MRI scan 15 days later revealed a hyperintense sign on the area postrema with no abnormal diffusion or contrast enhancement, compatible with isolated area postrema syndrome. An extensive workup for inflammation and other etiologies including neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody disorder, and multiple sclerosis (MS) showed negative results. The patient responded to treatment with methylprednisolone. Two months after the initial clinical manifestation, the patient developed fatigue, headache, and scalp tenderness. He was diagnosed with giant cell arteritis after ultrasonography and biopsy were performed. He responded well to oral glucocorticoids and had only 1 relapse during tapering. He has not had arteritic ischemic optic neuropathy or any new episodes of area postrema syndrome. DISCUSSION: This case demonstrates the importance of expanding the differential diagnosis in patients with area postrema syndrome and no other signs of NMOSD.
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spelling pubmed-101366732023-04-28 Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report da Silva, Matheus Alves de Carvalho, Barbara Maini de Queiroz, André Luiz Guimarães Lima, Karlla Danielle Ferreira Teixeira, Hennan Salzedas Schmid, Marcelo Freitas Campos, Christiane Monteiro de Siqueira Baeta, Alex Machado Neurol Neuroimmunol Neuroinflamm Clinical/Scientific Note OBJECTIVE: We report a case of biopsy-proven giant cell arteritis after an initial presentation of area postrema syndrome. METHODS: A 65-year-old man was evaluated using MRI, temporal artery biopsy, and ultrasound. RESULTS: The patient presented with refractory nausea, vomiting, and hiccups that caused weight loss without any other neurologic or clinical symptoms. His MRI scan 15 days later revealed a hyperintense sign on the area postrema with no abnormal diffusion or contrast enhancement, compatible with isolated area postrema syndrome. An extensive workup for inflammation and other etiologies including neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody disorder, and multiple sclerosis (MS) showed negative results. The patient responded to treatment with methylprednisolone. Two months after the initial clinical manifestation, the patient developed fatigue, headache, and scalp tenderness. He was diagnosed with giant cell arteritis after ultrasonography and biopsy were performed. He responded well to oral glucocorticoids and had only 1 relapse during tapering. He has not had arteritic ischemic optic neuropathy or any new episodes of area postrema syndrome. DISCUSSION: This case demonstrates the importance of expanding the differential diagnosis in patients with area postrema syndrome and no other signs of NMOSD. Lippincott Williams & Wilkins 2023-04-25 /pmc/articles/PMC10136673/ /pubmed/37185110 http://dx.doi.org/10.1212/NXI.0000000000200113 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Clinical/Scientific Note
da Silva, Matheus Alves
de Carvalho, Barbara Maini
de Queiroz, André Luiz Guimarães
Lima, Karlla Danielle Ferreira
Teixeira, Hennan Salzedas
Schmid, Marcelo Freitas
Campos, Christiane Monteiro de Siqueira
Baeta, Alex Machado
Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report
title Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report
title_full Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report
title_fullStr Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report
title_full_unstemmed Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report
title_short Isolated Area Postrema Syndrome Preceding the Diagnosis of Giant Cell Arteritis: A Case Report
title_sort isolated area postrema syndrome preceding the diagnosis of giant cell arteritis: a case report
topic Clinical/Scientific Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136673/
https://www.ncbi.nlm.nih.gov/pubmed/37185110
http://dx.doi.org/10.1212/NXI.0000000000200113
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