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CASE REPORT
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 366-369

Intractable hiccups, nausea, and vomiting, an unnerving cause of vision loss


Department of Neuro-Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Correspondence Address:
Vaishali Venkatraman
Plot No. 105, Third East Cross Street, Annanagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.ojo_65_21

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Acute optic neuritis (ON) is caused by variety of complex disorders that can be differentiated with the help of history, radiology, and serology. Identification of nonneurological symptoms that occur before the demyelinating event aids in timely diagnosis and prevention of further neurological attacks. We describe a case of unilateral ON with a history of intractable hiccups, nausea, and vomiting, wherein the possibility of area postrema syndrome (APS) was overlooked until the development of visual symptoms. APS recently identified as a hallmark of neuromyelitis optica spectrum disorder is a rare neurologic cause of gastrointestinal symptoms. This atypical presentation of APS results from autoantibodies directed against the aquaporin-4 rich sites, such as area postrema. This case brings to light the importance of eliciting history of intractable hiccups, nausea, and vomiting in a patient with ON. Despite being a commonly encountered symptom, it may rarely raise a suspicion for neuromyelitis optica.


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