More Than Just a Hiccup: A case of Area Postrema syndrome followed by Acute respiratory failure in Neuromyelitis Optica Syndrome Disorder.

Introduction:Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease causing multifocal central nervous system (CNS) inflammation. It primarily affects the optic nerves and spinal cord, resulting in visual loss and paralysis.1,2Aquaporin-4 is a water channel protein densely expressed in the end-feet of astrocytes in the CNS. It has facilitated the distinction of NMOSD from other demyelinating disorders such as multiple sclerosis1.Area postrema syndrome (APS) is a clinical presentation of NMOSD which is characterized by gastrointestinal manifestations like nausea and vomiting, even in the absence of neurological manifestations2.This results in a diagnostic dilemma and misdiagnosis, which can delay care. Added to this, some patients develop respiratory failure which can prove fatal3.