Intractable vomiting as the initial presentation of neuromyelitis optica

Metha Apiwattanakul, Bogdan F. Popescu, Marcelo Matiello, Brian G. Weinshenker, Claudia F. Lucchinetti, Vanda A. Lennon, Andrew McKeon, Adam F. Carpenter, Gary M. Miller, Sean J. Pittock

Research output: Contribution to journalArticlepeer-review

130 Scopus citations


We report 12 aquaporin-4 antibody-positive patients (12% of seropositive Mayo Clinic patients identified since 2005) whose initial presenting symptom of neuromyelitis optica was intractable vomiting. The initial evaluation in 75% was gastroenterologic. Vomiting lasted a median of 4 weeks (range, 2 days-80 weeks). Optic neuritis or transverse myelitis developed after vomiting onset in 11 patients (median interval, 11 weeks; range, 1-156). At last evaluation (median, 48 months after vomiting onset), 7 patients fulfilled neuromyelitis optica diagnostic criteria. Our clinical, pathologic and neuroimaging observations suggest the aquaporin-4-rich area postrema may be a first point of attack in neuromyelitis optica. Ann Neurol 2010;68:757-761

Original languageEnglish (US)
Pages (from-to)757-761
Number of pages5
JournalAnnals of neurology
Issue number5
StatePublished - Nov 2010

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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