Dorsal medulla, area postrema, and other brainstem lesions in neuromyelitis optica spectrum disorders

Sagittal T2-weighted FLAIR MRI shows a lesion in the dorsal medulla (A, arrow). Sagittal T2-weighted (B) and T1-weighted MRI with gadolinium (C) each demonstrate an acute lesion (arrows) associated with area postrema clinical syndrome. Axial T2-weighted FLAIR (D, arrows) and T1-weighted MRI with gadolinium (E, arrowheads) show dorsal medulla involvement in a patient with acute area postrema clinical syndrome. Axial T2-weighted FLAIR MRI shows periependymal lesions involving the pons (F, arrows) and dorsal midbrain (G, arrow). Sagittal T2-weighted FLAIR MRI shows increased signal surrounding the fourth ventricle (H, arrows).