Intractable vomiting and hiccups as the presenting symptom of neuromyelitis optica

Abstract

Vomiting and hiccups can be due to peripheral or central causes. Neurological diseases causing vomiting and hiccups are due to lesions of medulla involving area postrema and nucleus tractus solitarius. Neuromyelitis optica (NMO) is one such disease which involves these structures. However refractory vomiting and hiccups as the presenting symptom of NMO is unusual. Here we report a patient with NMO in whom refractory vomiting and hiccups were the sole manifestation of the first attack. Diagnosis can be missed at this stage leading to delay in treatment and further complications. This case demonstrates the importance of considering NMO in any patient presenting with refractory vomiting and hiccups and with local and metabolic causes ruled out and linear medullary lesion on magnetic resonance imaging may indicate the diagnosis even when the classical clinical criteria are not met. Anti NMO antibody testing should be done and if positive appropriate treatment should be initiated to prevent further neurological damage.

Intractable Hiccups due to Isolated Parainfectious Myelitis

“…The classical demyelinating disorder in which refractory vomiting and hiccups may rarely be the sole manifestation of the first attack, is NMO, which was first described by Eugene Devic in 1894. 8,9 Oversight may lead to the diagnosis being missed at this stage leading to delay in treatment and further complications. NMO spectrum disorder (NMOSD) is now recognized to be a relapsing disease rather than purely a monophasic disorder including atypical presentations, such as hypersomnia, intractable hiccups, nausea, vomiting, transient elevation of creatine kinase level, and painful tonic limb spasm.…”

Intractable vomiting caused by vertebral artery compressing the medulla: A case report

“…Less than 10 cases of nausea and vomiting due to vertebral artery compression have been reported in the literature. [ 5 6 ] Of the 20 cases of vertebral artery compression of the medulla reported in a meta-analysis by Savitz et al ., only one patient experienced nausea and vomiting as a symptom. The majority of patients presented with hemiparesis and cranial nerve dysfunction.…”

“…The majority of patients presented with hemiparesis and cranial nerve dysfunction. [ 5 ] MVD was the choice of treatment for 17 of the patients, including the patient with symptoms of nausea, and it was shown to relieve symptoms in 16 patients.…”

Area postrema lesion as a cause of intractable nausea, vomiting and hiccups in neuromyelitis optica spectrum disorders

“…Правильная диагностика в этой ситуации является крайне сложной задачей. В подавляющем большинстве случаев пациенты наблюдаются у гастроэнтерологов, терапевтов или врачей общей практики и им проводится расширенное обследование ЖКТ, не выявляющее, однако, диагностически значимых изменений [14][15][16][17][18].…”

“…Представленное клиническое наблюдение демонстрирует диагностические сложности при возникновении синдрома поражения area postrema и дна IV желудочка в дебюте оптикомиелит-ассоциированного расстройства. По мнению большинства авторов [12,14,16,17], при развитии у пациента неукротимой икоты, тошноты и рвоты после исключения патологии ЖКТ и инфекционного заболевания целесообразно выполнение анализа крови на антитела к аквапорину-4 и нейровизуализации. Своевременная правильная постановка диагноза и назначение патогенетической терапии могут предотвратить в дальнейшем тяжелое и инвалидизирующее поражение спинного мозга и зрительных нервов.…”