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Intractable vomiting and the medulla: neuromyelitis optica spectrum disorder presenting as area postrema syndrome
  1. Ami Schattner1,
  2. Arnon Karni2,3
  1. 1 The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel
  2. 2 Neuroimmunology Clinic, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  3. 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to Professor Ami Schattner, The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel; amischatt{at}gmail.com

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A healthy 61-year-old woman developed frequent vomiting, nausea and hiccups associated with marked weight loss. Examination and laboratory tests were normal. Countless visits to her general practitioner, many consultants and multiple investigations including neuroimaging yielded nothing. After 10 weeks, gait ataxia developed. Thiamine led to slight improvement. When leg paresthesiae and difficulty urinating appeared, she was admitted, although vomiting had subsided. Paraparesis and urinary retention were found and MRI demonstrated subtle lesions involving the pons and medulla with associated transverse myelitis (figures 1 and …

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