Clinical analysis of neuromyelitis optica with gastrointestinal symptoms as onset / 中华神经医学杂志

ABSTRACT

Objective To study the clinical features of patients with neuromyelitis optica (NMO) having initial symptom of intractable hiccup and nausea (INH) to improve the recognition of the disease.Methods Fourteen patients with NMO having INH as onset,admitted to our hospital from January 2015 to April 2016,were chosen.The onset characteristics,cerebrospinal fluid (CSF) results,serum aquaporins (AQP)4 antibody level,head and neck MR imaging of these patients were retrospectively analyzed.Results NMO with INH as onset was more common in young and middle-aged women;and the symptom was stubborn.Leukocyte increased slightly and total protein was normal or slightly increased in CSF.The positive rate of AQP4 antibody in serum was 79％ and oligoclonal band in CSF was 17％.MR imaging showed 8 patients (57％) had lesions in bulbar tegmentum and area postrema,6 patients (43％) had high cervical cord lesions without medullary lesion;most of the lesions in medulla oblongata and high cervical cord were linear;5 patients (36％) had abnormal signal of brain stem,corpus callosum and cerebral cortex.It was isointense or hypointensity on T1WI and hyperintense on T2WI and FLAIR sequences.Conclusions Antiemetic therapy of NMO with INH as onset is ineffective;the initial symptom is INH,followed by optic neuritis and/or myelitis symptoms.MR imaging shows lesions including bulbar tegmentum and area postrema,or linear signal changes in medulla and spinal cord.