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Neuromyelitis optica spectrum disorders with multiple brainstem manifestations: a case report

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Abstract

Background

Multiple brainstem manifestations have been rarely reported during the same attack in neuromyelitis optica spectrum disorders (NMOSD).

Case presentation

We describe a 39-year-old Asian woman presenting multiple brainstem manifestations including intractable nausea and vomiting, vertigo, diplopia, facial palsy, hypogeusia, ophthalmoplegia, hemiplegia, dysphagia and tonic spasm during the same attack. Hypogeusia was transient and recovered without any immunotherapy. The brain MRIs showed progressive multiple lesions in the brainstem. NMO-IgG (aquaporin4-antibody, AQP4-Ab) were positive in both serum and cerebral spinal fluid. The symptoms and signs were controlled after immunosuppressive therapy. No relapse happened during the 15-month follow-up.

Conclusion

This report emphasizes multiple brainstem manifestations during the same attack in NMOSD and the most characteristic symptom was reversible hypogeusia.

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Fig. 1

Abbreviations

NMOSD:

Neuromyelitis optica

MRI:

Magnetic resonance imaging

CSF:

Cerebral spinal fluid

AQP-4:

Aquaporin 4

AQP4-Ab:

Aquaporin 4 antibody

VEP:

Visual evoke potential

ON:

Optic nerve

LEM:

Longitudinally extensive myelitis

ELISA:

Enzyme linked immunosorbent assay

NTS:

Nucleus tractus solitaries

INH:

Intractable nausea and vomiting

MO:

Medulla oblongata

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Acknowledgments

I would like to thank Dr. Jimei Li and Dr. Ruijin Wang for review of the manuscript and helpful comments.

Conflict of interest

The authors declare that there are no conflicts of interest.

Informed consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

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Author notes

    Authors and Affiliations

    1. Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China

      Yao Li, Bin Jiang, Bin Chen, Mingxia Zhao, Chunlai Zhou, Shuhui Wang, Jimei Li & Ruijin Wang

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    1. Yao Li
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    2. Bin Jiang
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    3. Bin Chen
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    4. Mingxia Zhao
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    6. Shuhui Wang
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    7. Jimei Li
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    8. Ruijin Wang
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    Corresponding author

    Correspondence to Jimei Li.

    Additional information

    Y. Li and B. Jiang contributed equally to this work.

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    Li, Y., Jiang, B., Chen, B. et al. Neuromyelitis optica spectrum disorders with multiple brainstem manifestations: a case report. Neurol Sci 37, 309–313 (2016). https://doi.org/10.1007/s10072-015-2196-z

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