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Intractable nausea, vomiting, and hiccups are characteristic symptoms associated with neuromyelitis optica spectrum disorder (NMOSD) as the result of immune-mediated lesions affecting the area postrema and medullary floor of the fourth ventricle. Reports of paroxysmal sneezing as part of the NMOSD phenotype are rare. We present a case of a patient who developed symptoms of NMOSD associated with prominent paroxysmal sneezing as a heralding symptom. The precise location of the human sneeze center has not been identified; this case provides further evidence for its location in the dorsolateral medulla as previously proposed.1

Paroxysmal sneezing in NMOSD: Further evidence of the localization of the human sneeze center