Open AccessAREA POSTREMA SYNDROME – A CHALLENGE FOR DIFFERENTIAL DIAGNOSIS BETWEEN MULTIPLE SCLEROSIS AND NEUROMYELITIS OPTICA SPECTRUM DISORDERS
Author(s) -
Adriana Octaviana Dulămea,
Ioan-Cristian Lupescu
Publication year - 2017
Publication title -
romanian journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 4
eISSN - 2069-6094
pISSN - 1843-8148
DOI - 10.37897/rjn.2017.4.4
Subject(s) - medicine , area postrema , hiccups , neuromyelitis optica , nausea , multiple sclerosis , differential diagnosis , vomiting , radiology , pediatrics , surgery , pathology , psychiatry , central nervous system
Area postrema syndrome (APS) manifested with hiccups, nausea and vomiting is one of the core clinical findings in neuromyelitis optica spectrum disorders (NMOSD). We report the case of a 41-year-old woman, with no significant prior medical history, who presented with left upper limb paresthesias. The patient revealed two prior episodes, one 5 years ago, with paresthesias and mild paresis on the right side of the body and the other a few month ago, with right peripheral facial palsy, right facial anesthesia, headache, nausea and emesis. This led us to suspect area postrema syndrome and, possibly, NMOSD. Brain MRI did not show typical lesions for NMOSD, apart from a left periaqueductal lesion. Other potential diagnoses were excluded through laboratory workup. Serum anti-AQP4 antibody were negative, while CSF analysis was positive for oligoclonal bands. Based on clinical and paraclinical findings, a diagnosis of MS was made. This case illustrated that APS may also be present in MS and not only in NMOSD.