We report 12 aquaporin-4 antibody-positive patients Mayo Clinic patients identifiesince 2005) whose initial presenting symptom of neuromyelitis optica was intractable vomiting. The initialevaluation in 75% was gastroenterologic. Vomiting lasted a median of 4 weeks (range, 2 days–80 weeks. Optic neuritis or transverse myelitis developed aftervomiting onset in 11 patients (median interval, 11 weeks; range, 1–156). At last evaluation (median, 48 months after vomiting onset), 7 patients fulfilled neuromyelitis optica diagnostic criteria. Our clinical, pathologic and neuroimaging observations suggest the aquaporin-4–rich area postrema may be a first point of attack in neuromyelitis optica.
Read More: Intractable Vomiting as the Initial Presentation of Neuromyelitis Optica