Area postrema syndrome

Shosha, Eslam; Dubey, Divyanshu; Palace, Jacqueline; Nakashima, Ichiro; Jacob, Anu; Fujihara, Kazuo; Takahashi, Toshiyuki; Whittam, Daniel; Leite, Maria Isabel; Misu, Tatsuro; Tokura, Y.; Messina, Silvia; Elsone, Liene; Majed, Masoud; Flanagan, Eoin P.; Gadoth, Avi; Huebert, Carey; Sagen, Jessica; Greenberg, Benjamin; Lévy, Michaël; Banerjee, Aman; Weinshenker, Brian G.; Pittock, Sean J.

doi:10.1212/wnl.0000000000006392

Cited by 138 publications

(76 citation statements)

References 28 publications

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“…We found that area postrema relapses were more common at first presentation than with subsequent relapses. This finding is contrary to a recent larger study of several international cohorts (16). However, we note the definition for area postrema syndrome used in that study was broader than the definition used in the present study.…”

Section: Discussioncontrasting

confidence: 99%

Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation

et al. 2020

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Section: Discussioncontrasting

confidence: 99%

Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation

et al. 2020

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“…The AQP-4 antibody binding triggers complement activation and subsequently the downstream effects and histopathology seen in NMSOD. Patients also commonly present with blindness and paralysis due to AQP-4 protein density on optic nerves and spinal cord, whereas isolated APS attacks in AQP-4-positive NMOSD have a prevalence of 7.1-14.5% [6,7].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Induced Area Postrema Syndrome With Intractable Nausea, Vomiting, and Hiccups

Cohen

Craven

Bragin

2020

Cureus

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The area postrema (AP) is a small, circumventricular organ located in the dorsal medulla and is characterized by an anastomosed capillary network with no blood-brain barrier. It contains the chemoreceptor trigger zone for vomiting, which is activated by noxious stimuli in the blood. Lesions to the AP produce a clinical syndrome referred to as area postrema syndrome (APS), which is characterized by intractable nausea, vomiting, and hiccups. APS manifests frequently as neuromyelitis optica spectrum disorders (NMOSD), where antibodies attack aquaporin-4 receptors, which are found in abundance in the AP. Its vascular supply is delivered by the anterior spinal artery or, at times, by small vessel branches of the vertebral artery itself. Ischemic stroke is the fifth leading cause of death in the United States; however, APS due to ischemic stroke has rarely been described. We present a case of a 62-year-old male with ischemic stroke in the cerebellum and brainstem, which produced intractable APS due to extension within his AP. He was treated with metoclopramide 10 mg four times daily and ondansetron 8 mg every eight hours, which relieved his symptoms. Recognizing that the patient's intractable nausea and vomiting was attributable to AP involvement was valuable in limiting further extraneous workup and focusing on our medical management. Ischemic stroke should be considered in the differential for APS. Given the size of the AP, thin-cut highresolution diffusion-weighted MRI is warranted in patients with clinical APS. Recognizing that intractable nausea and vomiting may be attributable to stroke is valuable in mitigating extraneous and ineffective medical management. The patient case we describe in our report further outlines these findings.

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“…Area postrema syndrome/lesions have been identified as disease-defining symptoms for AQP4-positive NMOSD (13,14); however, this syndrome/localization is not specific (14). In Case I, we observed extensive myelitis extending from the dorsal medulla to C6; however, the patient's history was unremarkable for intractable nausea, vomiting, or hiccups.…”

Section: Discussionmentioning

confidence: 79%

Case Series: Myelin Oligodendrocyte Glycoprotein-Immunoglobulin G-Related Disease Spectrum

et al. 2020

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Introduction:Myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG)-related disease was initially described as a subtype of neuromyelitis optica spectrum disorder (NMOSD) with antibodies against MOG. However, it has recently been described as a separate disease entity with clinical and radiological features that overlap those of multiple sclerosis (MS) and NMOSD; the clinical features of this disease phenotype remain undetermined. We herein report the clinical presentation of nine MOG-IgG-positive patients, not all of whom fulfill the NMOSD criteria, in order to highlight the features and challenges of this condition. Method:We retrospectively reviewed the records of the London (Ontario) MS clinic to identify patients diagnosed with positive MOG antibodies based on the 2015 NMOSD consensus criteria.Result: Nine patients were identified, all Caucasian. Seven (78%) were female, and the median age of onset was 41 years (range, 28-69 years); the median Expanded Disability Status Scale score at onset was 3.0 (range, 2.0-4.0). A monophasic course was noted in two (22.2%) patients, while the median number of relapse events was 3 (range 2-5) in 77.8% of the patients. Optic neuritis and transverse myelitis contributed equally as initial manifestations in three individuals (33%), while brainstem relapse was reported in two individuals (22%). The brain magnetic resonance imaging findings were compatible with McDonald's 2010 dissemination in space criteria in three cases (33%). Short myelitis and an (H)-sign were each documented in one patient. Conclusion:The phenotypes of MOG Ab-positive cases exhibited overlapping features with MS and NMOSD. This finding highlights the importance of screening for anti-MOG in individuals with demyelinating symptoms, in consideration of the possibility of false-positive MOG Ab results.

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Area postrema syndrome

Cited by 138 publications

References 28 publications

Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation

Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation

Ischemic Stroke Induced Area Postrema Syndrome With Intractable Nausea, Vomiting, and Hiccups

Case Series: Myelin Oligodendrocyte Glycoprotein-Immunoglobulin G-Related Disease Spectrum

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