Misleading Medulla: Atypical NMOSD Masquerading as Posterior Circulation Stroke

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy which typically involve the optic nerves, spinal cord and brain stem regions. It?s an Aquaporin - 4 related channelopathy. Typically characterized by the core clinical features of optic neuritis, acute myelitis, area postrema syndrome, acute diencephalic syndrome, acute brainstem syndrome and symptomatic cerebral syndrome. Although clinical presentation of the patients can be variable. Herein we report an interesting case of 33 - year young female patient who initially presented with acute onset ataxia and vertigo, her imaging was suggestive of right lateral medullary infarct. Therefore, she was started on antiplatelets and statin. However, patient clinically worsened along with new symptoms. On further evaluation, patient serum serology was strongly positive for Aquaporin - 4 antibody thus turning out to be NMOSD. Subsequently our patient revealed that her maternal aunt also diagnosed with NMOSD four years back, suggesting likely a familial predisposition.