Area postrema may be entry site for pathogenic neuromyelitis optica-IgG

This case report supports the idea that fenestrated capillaries in the area postrema are an important initial entry site for pathogenic neuromyelitis optica-IgG in neuromyelitis optica spectrum disorders.

The authors reviewed MRI images from a 36-year-old woman who presented with hemiplegia and loss of pain and temperature sensation one day after the subacute onset of intractable vomiting. Paresthesia followed, and she was tetraplegic by day 12.

The initial MRI revealed a lesion in the medulla oblongata, involving primarily the area postrema. The lesion progressively extended into the upper cervical cord. Aquaporin-4 immunoglobulin (Ig)G was detected in serum.