Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of neuromyelitis optica spectrum disorder with persistent nausea and repeated syncope

Yoshinori Endo, M.D., Ph.D.1)2), Kouji Hayashi, M.D., Ph.D.1)2)3), Masamichi Ikawa, M.D., Ph.D.2), Osamu Yamamura, M.D., Ph.D.2), Kiyotaka Ookura, M.D., Ph.D.4) and Tadanori Hamano, M.D., Ph.D.2)5)

1)Department of Neurology, Fukui-ken Saiseikai Hospital
2)Department of Neurology, University of Fukui Hospital
3)Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University
4)Department of Cardiology, Fukui-ken Saiseikai Hospital
5)Department of Aging and Dementia (DAD), Faculty of Medical Sciences, University of Fukui

A 22-year-old woman was admitted to our hospital with persistent nausea and no apparent cause. There was no preceding infection. The patient lost consciousness for several seconds. Based on an electrocardiographic diagnosis of paroxysmal sinus arrest (PSA), a temporary pacemaker was implanted. She did not develop syncope, but vertigo, nystagmus, diplopia, and limb paresthesia were observed. Brain MRI revealed a high-intensity lesion in the dorsal medulla on FLAIR images. As the serum anti-aquaporin 4 (AQP4) antibody was positive, the patient was diagnosed with neuromyelitis optica spectrum disorder (NMOSD). After she received steroid pulse therapy (methylprednisolone at 1,000 mg/day for three days) twice, her symptoms markedly improved. In this patient, PSA was considered to be a symptom of area postrema syndrome of NMOSD. Therefore, NMOSD should be considered as a possible cause of PSA.
Full Text of this Article in Japanese PDF (805K)

(CLINICA NEUROL, 60: 142|145, 2020)
key words: NMO spectrum disorder, persistent nausea, syncope, sinus arrest, area postrema syndrome

(Received: 25-Jul-19)