A Clinical Analysis Of 22 Cases Of Autoimmune Diseases In The Posterior Zone Syndrome

Objective To study the clinical manifestations,imaging and laboratory features of the postrema area syndrome and to raise awareness of the disease.Methods The clinical data of 22 patients with postrema area syndrome were collected and their clinical features,cranial and spinal MRI,important laboratory examinations,and diagnosis and treatment procedures were analyzed.Results The postrema area syndrome is common in patients with NMOSD and brain stem inflammation,and is more common in women(15/22).The age of onset is 19-62(average34.5)years.INH was present in 22 patients,of which 17 patients had INH as the initial symptom,5 patients had ON,ATM or dizziness,and core clinical symptoms showed 11 or 2 eyes with optic neuritis,and 12 had ATM performance.11 The other brain stem lesions appeared.Six patients received serum aquaporin 4(AQP4)-IgG positive in 4 cases and negative in 2cases.All 4 cases were negative in cerebrospinal fluid oligoclonal bands,and 5cases had autoantibodies(antinuclear antibodies,anti-SS-A antibody,anti-Ro-52 antibody,anti-SS-B antibody,anti-histone antibody)positive.The cranial MRI of 22 patients showed that the lesions were mainly distributed around the central plexus,such as the aqueduct of the medulla oblongata,the posterior pole region,and the pons.The lesions were often round,patchy and long T1 and long T2 signals.Only MRI showed 8 lesions in the medulla oblongata,5 lesions in the medulla and hemisphere,2 lesions in the medulla and spinal cord,and 7 lesions in the medulla,hemisphere,and spinal cord.There were 15 cases of misdiagnosis,including 12 cases of digestive diseases,1 case of posteriorcirculation ischemia,1 case of neurogenic vomiting,and 1 case of cerebral infarction.Conclusions The posterior quadrant syndrome manifested mostly as unresolved obstinate hiccups and/or nausea and vomiting,and the symptoms lasted longer than 48 hours;Head and neck MRI can be used for early diagnosis and improve diagnostic accuracy;(AQP4)-IgG can help with clinical diagnosis.