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Table of Contents
LETTER TO THE EDITOR
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 47-48

Core clinical characteristics of neuromyelitis optica spectrum disorder mnemonic


Department of Neurology; Department of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, Brazil

Date of Submission14-Nov-2019
Date of Acceptance04-Dec-2019
Date of Web Publication12-Feb-2020

Correspondence Address:
Mr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande Do Sul
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_140_19

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How to cite this article:
Rissardo JP, Caprara AL. Core clinical characteristics of neuromyelitis optica spectrum disorder mnemonic. Indian J Med Spec 2020;11:47-8

How to cite this URL:
Rissardo JP, Caprara AL. Core clinical characteristics of neuromyelitis optica spectrum disorder mnemonic. Indian J Med Spec [serial online] 2020 [cited 2020 Feb 20];11:47-8. Available from: http://www.ijms.in/text.asp?2020/11/1/47/278091



Dear Editor,

We read the article entitled “Area postrema syndrome: A lesser known variant of neuromyelitis optica spectrum disorder” on the esteemed “Indian Journal of Medical Specialities” with great interest. Mittal et al. reported the first case of area postrema syndrome in an adult female from India.[1]

Here, we would like to provide the mnemonic “brain stem more neuromyelitis optica spectrum disorder (NMOSD)” and [Figure 1] for help to remember the core clinical characteristics for the diagnosis of NMOSD [Table 1].[2]
Figure 1: Schematic diagram of the core clinical characteristics of neuromyelitis optica spectrum disorder. 1: Brain stem, 2: nausea, 3: myelitis, 4: optic, 5: specific cerebral lesion, 6: diencephalic

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Table 1: Neuromyelitis optica spectrum disorder diagnostic criteria for adult patients with AQ4-IgG

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The area postrema is one of the circumventricular organs which are organs with highly permeable capillaries. It allows that this structure of the medulla oblongata is able to function as a sensor for circulating chemical messengers as well as integrating neural inputs in the brain stem. The area postrema is well known as the part of the brain stem that controls vomiting.[3] In addition, it was already reported in case reports in association with cyclical vomits, where was observed a focal lesion in the area postrema and the patient was successfully managed with medical marijuana.[4] However, besides vomits and neuromyelitis optica, this region is also associated with fetal maturation, tumors, and growth. Sarnat et al. studied human fetal brains at autopsy in the three trimesters; they found that this exhibited cytologic maturity and synaptic circuitry throughout the gestation and during the postnatal months.[5]

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mittal GK, Sekhar S, Mathew JJ, Singhdev J. Area postrema syndrome: A lesser known variant of neuromyelitis optica spectrum disorder. Indian J Med Spec 2019;10:222-4.  Back to cited text no. 1
  [Full text]  
2.
Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015;85:177-89.  Back to cited text no. 2
    
3.
Popescu BF, Lennon VA, Parisi JE, Howe CL, Weigand SD, Cabrera-Gómez JA, et al. Neuromyelitis optica unique area postrema lesions: Nausea, vomiting, and pathogenic implications. Neurology 2011;76:1229-37.  Back to cited text no. 3
    
4.
Hirsch E, Gierlich J, Glants E, Sheikh T, Duran D, Krishna R. Cyclical Vomiting Associated with a Focal Lesion of the Area Postrema Successfully Managed with Medical Marijuana (P3. 9-053). AAN Enterprises; 2019.  Back to cited text no. 4
    
5.
Sarnat HB, Flores-Sarnat L, Boltshauser E. Area Postrema: Fetal Maturation, Tumors, Vomiting Center, Growth, Role in Neuromyelitis Optica. Pediatr Neurol 2019;94:21-31.  Back to cited text no. 5
    


    Figures

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    Tables

  [Table 1]



 

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