Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom

Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomitin...
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Autor*in:	Ting Liu [verfasserIn] Lijuan Li [verfasserIn] Xiaopeng Guo [verfasserIn] Qifu Li [verfasserIn] Dandan Jia [verfasserIn] Lin Ma [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2022

Schlagwörter:	Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers

Übergeordnetes Werk:	In: European Journal of Medical Research - BMC, 2012, 27(2022), 1, Seite 9
Übergeordnetes Werk:	volume:27 ; year:2022 ; number:1 ; pages:9

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/s40001-022-00949-9

Katalog-ID:	DOAJ000811440

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520			\|a Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.
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allfields	10.1186/s40001-022-00949-9 doi (DE-627)DOAJ000811440 (DE-599)DOAJe644feac9894433d80a5f1cb5b95bcff DE-627 ger DE-627 rakwb eng Ting Liu verfasserin aut Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease. Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers Medicine R Lijuan Li verfasserin aut Xiaopeng Guo verfasserin aut Qifu Li verfasserin aut Dandan Jia verfasserin aut Lin Ma verfasserin aut In European Journal of Medical Research BMC, 2012 27(2022), 1, Seite 9 (DE-627)375977775 (DE-600)2129989-4 2047783X nnns volume:27 year:2022 number:1 pages:9 https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/article/e644feac9894433d80a5f1cb5b95bcff kostenfrei https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/toc/2047-783X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 27 2022 1 9
spelling	10.1186/s40001-022-00949-9 doi (DE-627)DOAJ000811440 (DE-599)DOAJe644feac9894433d80a5f1cb5b95bcff DE-627 ger DE-627 rakwb eng Ting Liu verfasserin aut Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease. Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers Medicine R Lijuan Li verfasserin aut Xiaopeng Guo verfasserin aut Qifu Li verfasserin aut Dandan Jia verfasserin aut Lin Ma verfasserin aut In European Journal of Medical Research BMC, 2012 27(2022), 1, Seite 9 (DE-627)375977775 (DE-600)2129989-4 2047783X nnns volume:27 year:2022 number:1 pages:9 https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/article/e644feac9894433d80a5f1cb5b95bcff kostenfrei https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/toc/2047-783X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 27 2022 1 9
allfields_unstemmed	10.1186/s40001-022-00949-9 doi (DE-627)DOAJ000811440 (DE-599)DOAJe644feac9894433d80a5f1cb5b95bcff DE-627 ger DE-627 rakwb eng Ting Liu verfasserin aut Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease. Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers Medicine R Lijuan Li verfasserin aut Xiaopeng Guo verfasserin aut Qifu Li verfasserin aut Dandan Jia verfasserin aut Lin Ma verfasserin aut In European Journal of Medical Research BMC, 2012 27(2022), 1, Seite 9 (DE-627)375977775 (DE-600)2129989-4 2047783X nnns volume:27 year:2022 number:1 pages:9 https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/article/e644feac9894433d80a5f1cb5b95bcff kostenfrei https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/toc/2047-783X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 27 2022 1 9
allfieldsGer	10.1186/s40001-022-00949-9 doi (DE-627)DOAJ000811440 (DE-599)DOAJe644feac9894433d80a5f1cb5b95bcff DE-627 ger DE-627 rakwb eng Ting Liu verfasserin aut Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease. Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers Medicine R Lijuan Li verfasserin aut Xiaopeng Guo verfasserin aut Qifu Li verfasserin aut Dandan Jia verfasserin aut Lin Ma verfasserin aut In European Journal of Medical Research BMC, 2012 27(2022), 1, Seite 9 (DE-627)375977775 (DE-600)2129989-4 2047783X nnns volume:27 year:2022 number:1 pages:9 https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/article/e644feac9894433d80a5f1cb5b95bcff kostenfrei https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/toc/2047-783X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 27 2022 1 9
allfieldsSound	10.1186/s40001-022-00949-9 doi (DE-627)DOAJ000811440 (DE-599)DOAJe644feac9894433d80a5f1cb5b95bcff DE-627 ger DE-627 rakwb eng Ting Liu verfasserin aut Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease. Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers Medicine R Lijuan Li verfasserin aut Xiaopeng Guo verfasserin aut Qifu Li verfasserin aut Dandan Jia verfasserin aut Lin Ma verfasserin aut In European Journal of Medical Research BMC, 2012 27(2022), 1, Seite 9 (DE-627)375977775 (DE-600)2129989-4 2047783X nnns volume:27 year:2022 number:1 pages:9 https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/article/e644feac9894433d80a5f1cb5b95bcff kostenfrei https://doi.org/10.1186/s40001-022-00949-9 kostenfrei https://doaj.org/toc/2047-783X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 27 2022 1 9
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Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. 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author	Ting Liu
spellingShingle	Ting Liu misc Neuromyelitis optica spectrum disorders misc Area postrema syndrome misc Magnetic resonance imaging misc Biomarkers misc Medicine misc R Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom
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topic_title	Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom Neuromyelitis optica spectrum disorders Area postrema syndrome Magnetic resonance imaging Biomarkers
topic	misc Neuromyelitis optica spectrum disorders misc Area postrema syndrome misc Magnetic resonance imaging misc Biomarkers misc Medicine misc R
topic_unstemmed	misc Neuromyelitis optica spectrum disorders misc Area postrema syndrome misc Magnetic resonance imaging misc Biomarkers misc Medicine misc R
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title	Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom
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title_sort	clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom
title_auth	Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom
abstract	Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.
abstractGer	Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.
abstract_unstemmed	Abstract Objective The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.
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title_short	Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom
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Methods Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. Results Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. Conclusion The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. 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Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom

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