NMOSD – Area Postrema Syndrome — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationNMOSD – Area Postrema SyndromeSCE Neurology

A 55-year-old woman with AQP4-positive NMOSD presents with intractable hiccups and nausea lasting 3 weeks. MRI brain shows a lesion in the area postrema of the medulla. What does this presentation represent?

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Correct answer: E — An NMOSD relapse involving the area postrema

The best answer is “An NMOSD relapse involving the area postrema”. MS care requires phenotype confirmation, relapse assessment, symptom management and specialist disease-modifying therapy; ocrelizumab is an NHS option for eligible early inflammatory primary progressive disease. The alternatives “An MS relapse, when the phenotype supports it”, “A brainstem stroke, within the relevant UK pathway”, “CNS lymphoma, after excluding important mimics”, “Functional neurological disorder, after specialist assessment” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations