Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica

Abstract

Neuromyelitis optica is an inflammatory disorder of the central nervous system. It involves the immune-mediated demyelination of predominantly the optic nerves and the spinal cord, which can lead to optic neuritis and transverse myelitis, respectively. Patients usually present with symptoms related to the eyes or the spinal cord, like loss of vision, pain in the eyes, visual field defects or numbness and weakness of limbs. Vomiting and hiccups are common cases encountered in medicine clinics and can sometimes be an atypical presentation of this disorder. Here we present a case of a 33-year-old female who initially presented to our tertiary care centre with repeated episodes of bilious vomiting and intractable hiccups for 10 days. After multiple investigations over a couple of days, the patient was found to be positive for anti-NMO antibodies and displayed neuro-radiological findings on MRI brain and spine, which finally led to the diagnosis of neuromyelitis optica spectrum disorder (NMOSD). Through this case we highlight the importance of suspecting NMO in a patient with complaints of intractable vomiting and hiccups, so that early intervention and treatment can prevent further disabling complications of the disease.

Observation of Clinical Efficacy of Anisodamine and Chlorpromazine in the Treatment of Intractable Hiccup after Stroke

“…In the N-dimensional space, there are R particles, and each particle needs to have a rate and position. Equations (11) and (12) show how the rate and position of the j-th class of the i-th particle are calculated.…”

“…In Equations ( 11) and (12), n represents the current number of iterations, i = 1, 2 ⋯ R represents the indexes of particles, and j = 1, 2 ⋯ n represents the dimension of particle space. C 1 and C 2 express the acceleration coefficients, and W expresses the degree to which the forward velocity of the particle affects the present velocity.…”

“…Stroke is often accompanied by intermittent and recurrent hiccups sometimes followed by vomiting, reflux, aspiration, and other aggravating conditions which not only affect patients' sleep but also make them in a poor mood [7][8][9]. Stroke patients with dry heat, hyperactivity of liver-yang, qi stagnation and phlegm obstruction, and deficiency of liveryin and kidney-yin can cause the internal wind to multiply the lung and stomach, which results in gastric qi trapping on the phlegm and moving the diaphragm, thus causing hiccups [10][11][12][13]. According to some research, chlorpromazine is injected into the bilateral Neiguan acupoint for the treatment of intractable hiccups, which has good effects.…”

Cerebral venous sinus thrombosis presenting as subarachnoid hemorrhage in a neuromyelitis optica spectrum disorder with positive anti-cardiolipin antibodies: a case report

“…Area postrema syndrome is an important core feature of NMOSD, which is usually characterized by the vulnerability of this region to attack by aquaporin-4 (AQP-4) antibodies and damage to important structures in the area postrema such as the medulla oblongata and adjacent solitary nucleus and nucleus ambiguus. Intractable hiccup and nausea (IHN), which can appear early in the course of NMOSD and is often confused with gastrointestinal disease and delayed (1,5) . CVST is a group of cerebrovascular diseases caused by various causes of cerebral venous system circulation disorders, which have a low incidence and mostly present clinically as headache, vomiting, seizures, and focal neurological de cits, but manifest as SAH is only about 1% (6,7) .Unlike aneurysmal SAH, SAH complicated by CVST is limited and small in volume, but the mechanism is not fully understood.…”

Síntomas gastrointestinales como manifestación de neuromielitis óptica: un reporte de caso

“…En reporte de casos en diferentes países se describen retrasos en el tratamiento debidos a diagnósticos tardíos explicables por la presencia de hipo y vómito, considerados inusuales. Una vez definida la necesidad de tratamiento farmacológico, se empleó esteroide venoso por cinco días para manejo de la crisis aguda, con transición a esteroide oral y azatioprina para control de la enfermedad [26][27][28] .…”