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Neuromyelitis optica: an elusive cause of dysphagia
  1. Oliver Cousins1,
  2. Elena Girelli2 and
  3. Sreedharan Harikrishnan1,3
  1. 1 Department of Neurology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
  2. 2 Faculty of Life Sciences and Medicine, King’s College London School of Medical Education, London, UK
  3. 3 Department of Neurology, King’s College London School of Medical Education, London, UK
  1. Correspondence to Dr Oliver Cousins, o.cousins{at}


Neuromyelitis optica spectrum disorder (NMOSD) is a rare neurological condition infrequently associated with dysphagia on initial presentation. We describe the case of a 54-year-old woman who presented multiple times to healthcare professionals with severe vomiting, followed by sudden profound dysphagia. Her diagnosis was elusive, initially attributed to achalasia cardia and subsequently to stroke. A dorsal medullary lesion was revealed on MRI of the brain, which involved and extended beyond the area postrema. The patient required percutaneous gastrostomy, and repeated aspiration pneumonia complicated her clinical course. After aquaporin-4 antibodies returned positive, a diagnosis of NMOSD was made and she improved with immunosuppression. We discuss the process of lesion localisation and aetiology determination, as well as the difficulties that this case presented. Our hope is that this report will facilitate earlier diagnosis in similar cases in the future.

  • brain stem / cerebellum
  • cranial nerves
  • neuroimaging

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  • Contributors EG produced the initial draft of the background and clinical case description. OC produced the initial draft of the discussion and prepared the figures. OC also cared for the patient. SH cared for the patient and edited the manuscript. All authors edited and agreed on the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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