To describe the clinical manifestation and outcomes in patients with Area postrema Syndrome

Study was conducted in a tertiary care neuroimmunology clinic from Jan 2016 to Jan 2018. All patients with clinical features of APS which was confirmed on MRI were included for the study.  There clinical features, CSF parameters, Aquaporin antibody status, treatment patterns and outcomes were analyzed.

  During the study period of two years, six patients presented with APS with a   male to female ratio of 1:5 and median age of 28years, age ranging from 22 to 65 years.

All six patients had nausea and vomiting but hiccups was present in only 4 patients. Mean duration of symptoms before presentation to neurologist was 28 days (4 days to 4 months).

All were extensively investigated by Gastroenterologist and diagnosis assigned as gastritis (4), cyclic-vomiting syndrome (1) and gastroparesis. One patient was evaluated by a cardiologist and was put on Permanent pacemaker for symptomatic bradycardia.

Three had mild gait ataxia and two patients had dysarthria. MRI brain in all patients showed T2 hyperintensity involving area postrema and adjacent medulla with faint contrast enhancement in three patients. AntiAquaporin4 antibody was positive in 5(80%) of the patients.

Four (60%) patients responded to Methyl prednisolone and two patients received IVIG. One patient died due to intractable shock. 3 patients received rituximab as immunomodulation.