Postvaccination acute disseminated encephalomyelitis with area postrema syndrome and quasi benign paroxysmal positional vertigo: a case report

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Abstract

Area postrema syndrome (APS) develops in patients with lesions found in the floor of the fourth ventricle and manifests with nausea, intractable vomiting, and hiccup. APS is most commonly associated with neuromyelitis optica spectrum disorders although it may develop in some other conditions as well.

We have presented a case study of APS with positional vertigo developed in a 41-year-old woman caused by acute disseminated encephalomyelitis after COVID-19 vaccination. Quasi benign paroxysmal positional vertigo acutely manifested with nausea, vomiting, and vertigo that dramatically worsened with head movement. Physical examination revealed patchy hypesthesia on the left side of the face and decreased convergence of the left eye. MRI scan showed a lesion adjacent to the floor of the fourth ventricle (area postrema). The manifestations totally regressed on glucocorticoids without any relapse during 1-year follow-up.

About the authors

Enver I. Bogdanov

Kazan State Medical University; Republican Clinical Hospital

Email: enver_bogdanov@mail.ru
ORCID iD: 0000-0001-9332-8053

D. Sci. (Med.), Professor, Head, Department of neurology and rehabilitation

Russian Federation, 420101, Kazan, Mavlyutova str., 2; Kazan

Alexander Yu. Kazantsev

Kazan State Medical University

Email: engine90@bk.ru
ORCID iD: 0000-0001-9800-9940

Cand. Sci. (Med.), neurologist, assistant, Department of neurology, neurosurgery and medical genetics

Russian Federation, 420101, Kazan, Mavlyutova str., 2

Alsu G. Ahunova

Republican Clinical Hospital

Author for correspondence.
Email: eridan.kazan@gmail.com

neurologist

Russian Federation, 420101, Kazan, Mavlyutova str., 2

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2. Fig. 1. Patient's FLAIR MRI image. A small left-side lesion is visualized adjacently to the floor of the IV ventricle.

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3. Fig. 2. Schematic representation of the area postrema and the brainstem parts in the upper medulla oblongata [30]. The supposed affected area is dashed. Source: Jones J., Baba Y. Medulla oblongata. URL: https://radiopaedia.org/articles/5802 (data of access: 18.10.2021).

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Copyright (c) 2022 Bogdanov E.I., Kazantsev A.Y., Ahunova A.G.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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