Intractable Hiccups and Nausea as a Principal Symptom of Neuromyelitis Optica in a Patient with a Prior History of Miller-Fisher Syndrome

Abstract

Nausea is a common symptom and usually suggests a gastrointestinal disease rather than rare and severe neurological disorders such as neuromyelitis optica (NMO). A 69-year-old female with a prior history of Miller–Fisher syndrome presented with unremitting vomiting and hiccups. She was diagnosed with gastroenteritis over multiple visits to our hospital. However, she developed right-sided vision loss and bilateral lower extremity weakness. Magnetic resonance imaging of her spinal cord showed a lesion extending from T4 to L4, indicating transverse myelitis, and another lesion in the right ophthalmic nerve. Aquaporin-4 antibody testing was positive. A definitive diagnosis of NMO was made 23 days after the manifestation of her initial symptom however treatment produced only partial recovery of muscle weakness, and no recovery of her vision. It is important to make a timely diagnosis of NMO since specific treatment may be effective if provided at an earlier stage of the disease.