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A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system caused by severe immune-mediated demyelination and axonal destruction, mainly affecting optic nerves and the spinal cord. We describe a 26-year-old Nepalese woman with recent onset of headache,...

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Autores principales: Shrestha, Ramesh, Kharel, Ghanshyam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9589462/
https://www.ncbi.nlm.nih.gov/pubmed/36299670
http://dx.doi.org/10.1093/omcr/omac109
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author Shrestha, Ramesh
Kharel, Ghanshyam
author_facet Shrestha, Ramesh
Kharel, Ghanshyam
author_sort Shrestha, Ramesh
collection PubMed
description Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system caused by severe immune-mediated demyelination and axonal destruction, mainly affecting optic nerves and the spinal cord. We describe a 26-year-old Nepalese woman with recent onset of headache, nausea, vomiting and hiccups indicative of Area Postrema Syndrome (APS). The antibody test for aquaporin-4 was strongly positive. Brain magnetic resonance imaging (MRI) showed a bilateral hyperintense signal in the area postrema (AP). The patient started on methylprednisolone, and then azathioprine was added. However, the patient was readmitted because of tingling in her right upper extremity and sudden onset of tremors. An MRI scan showed an enlarged lesion in AP. Rituximab was started on top of the previous treatment, and a second dose was given after 2 weeks. The patient had been monitored regularly and symptom-free for 5 months. Hence, we emphasize the immediate need for a diagnostic approach for NMOSD management.
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spelling pubmed-95894622022-10-25 A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD Shrestha, Ramesh Kharel, Ghanshyam Oxf Med Case Reports Case Report Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system caused by severe immune-mediated demyelination and axonal destruction, mainly affecting optic nerves and the spinal cord. We describe a 26-year-old Nepalese woman with recent onset of headache, nausea, vomiting and hiccups indicative of Area Postrema Syndrome (APS). The antibody test for aquaporin-4 was strongly positive. Brain magnetic resonance imaging (MRI) showed a bilateral hyperintense signal in the area postrema (AP). The patient started on methylprednisolone, and then azathioprine was added. However, the patient was readmitted because of tingling in her right upper extremity and sudden onset of tremors. An MRI scan showed an enlarged lesion in AP. Rituximab was started on top of the previous treatment, and a second dose was given after 2 weeks. The patient had been monitored regularly and symptom-free for 5 months. Hence, we emphasize the immediate need for a diagnostic approach for NMOSD management. Oxford University Press 2022-10-22 /pmc/articles/PMC9589462/ /pubmed/36299670 http://dx.doi.org/10.1093/omcr/omac109 Text en © The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Shrestha, Ramesh
Kharel, Ghanshyam
A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD
title A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD
title_full A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD
title_fullStr A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD
title_full_unstemmed A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD
title_short A case report on recurrent area postrema syndrome in AQP4-IgG-positive NMOSD
title_sort case report on recurrent area postrema syndrome in aqp4-igg-positive nmosd
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9589462/
https://www.ncbi.nlm.nih.gov/pubmed/36299670
http://dx.doi.org/10.1093/omcr/omac109
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