{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:29:51Z","timestamp":1769725791857,"version":"3.49.0"},"reference-count":36,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T00:00:00Z","timestamp":1540944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005687","name":"Goethe-Universit\u00e4t Frankfurt am Main","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Area postrema (<jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content>) syndrome (defined as: nausea and\/or emesis and\/or singultus at onset of brainstem dysfunction) comprises complex pathophysiologic mechanisms triggered by different entities. The first objective was to assess the frequency of <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome as a clinical feature in brainstem encephalitis (<jats:styled-content style=\"fixed-case\">BE<\/jats:styled-content>). Finding an especially high prevalence of <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome in Bickerstaff brainstem encephalitis (<jats:styled-content style=\"fixed-case\">BBE<\/jats:styled-content>), we also analyzed the frequency of <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome in other autoimmune diseases with anti\u2010ganglioside antibodies (Guillain\u2013Barr\u00e9 syndrome (<jats:styled-content style=\"fixed-case\">GBS<\/jats:styled-content>) and its variants).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We systematically evaluated the prevalence of <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome in <jats:styled-content style=\"fixed-case\">BE<\/jats:styled-content> in all patients treated at our university hospital during a 15\u2010year period. In a second step, <jats:styled-content style=\"fixed-case\">BBE<\/jats:styled-content> patients were compared to <jats:styled-content style=\"fixed-case\">GBS<\/jats:styled-content> and Miller Fisher syndrome (<jats:styled-content style=\"fixed-case\">MFS<\/jats:styled-content>) patients as clinical subtypes of a disease continuum without brainstem dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome in 8 of 21 <jats:styled-content style=\"fixed-case\">BE<\/jats:styled-content> patients, including 3 of 7 <jats:styled-content style=\"fixed-case\">BBE<\/jats:styled-content> and in 4 of 112 <jats:styled-content style=\"fixed-case\">GBS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">MFS<\/jats:styled-content> patients. <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome was as a frequent but under\u2010recognized feature of <jats:styled-content style=\"fixed-case\">BE<\/jats:styled-content> with a significant impact on patients\u2019 well being.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Manifestation of <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome in <jats:styled-content style=\"fixed-case\">BBE<\/jats:styled-content> but also in <jats:styled-content style=\"fixed-case\">GBS<\/jats:styled-content> and its subtypes point toward a role of autoimmune antibodies that should be investigated in future studies. Considerable misdiagnosis or nonrecognition complicates diagnostic and therapeutic management. Therefore, <jats:styled-content style=\"fixed-case\">AP<\/jats:styled-content> syndrome should be considered in any episode of otherwise unexplained nausea, emesis, or singultus.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.666","type":"journal-article","created":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T04:10:32Z","timestamp":1541045432000},"page":"1534-1542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Area postrema syndrome as frequent feature of Bickerstaff brainstem encephalitis"],"prefix":"10.1002","volume":"5","author":[{"given":"Pia S.","family":"Zeiner","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital\/Goethe University Frankfurt Schleusenweg 2\u201016 Frankfurt\/Main 60528 Germany"},{"name":"Dr. Senckenberg Institute of Neurooncology University Hospital\/Goethe University Frankfurt Heinrich\u2010Hoffmann\u2010Strasse 7 Frankfurt\/Main 60528 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annemarie","family":"Brandhofe","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital\/Goethe University Frankfurt Schleusenweg 2\u201016 Frankfurt\/Main 60528 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"M\u00fcller\u2010Eschner","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology University Hospital\/Goethe University Frankfurt Schleusenweg 2\u201016 Frankfurt\/Main 60528 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmuth","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital\/Goethe University Frankfurt Schleusenweg 2\u201016 Frankfurt\/Main 60528 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waltraud","family":"Pfeilschifter","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital\/Goethe University Frankfurt Schleusenweg 2\u201016 Frankfurt\/Main 60528 Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,31]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.5441"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00849-X"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2344\/0003-3006-57.4.150"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainresrev.2007.06.002"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1073858407311100"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2015.00390"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-010-9454-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2013.01.028"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0031-9384(86)90149-6"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2005.05.017"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-933521"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22121"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000183151.19351.82"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318214332c"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2008.145391"},{"key":"e_1_2_8_17_1","first-page":"358","article-title":"The clinical analyses of neuromyelitis optica spectrum disorder initially presenting with area postrema syndrome in 14 patients","volume":"56","author":"Guo QF","year":"2017","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002655"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001729"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2017.02.002"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-013-6997-9"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2013.04.004"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.138"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2013.03.023"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12983"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.5223\/pghn.2015.18.2.128"},{"issue":"18","key":"e_1_2_8_27_1","first-page":"S459","article-title":"Granulomatous amebic encephalitis following hematopoietic stem cell transplantation","volume":"6","author":"Doan N","year":"2015","journal-title":"Surg Neurol Int."},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2015.12.018"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdj078"},{"key":"e_1_2_8_30_1","first-page":"100","article-title":"Effect of gingerol on cisplatin\u2010induced pica analogous to emesis via modulating expressions of dopamine 2 receptor, dopamine transporter and tyrosine hydroxylase in the vomiting model of rats","volume":"59","author":"Qian W","year":"2016","journal-title":"Yonago Acta Med."},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awg233"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2012-302824"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-4159.2007.04718.x"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1021\/cn100096h"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biochi.2017.05.016"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chroma.2006.05.033"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasms.2004.08.002"}],"container-title":["Annals of Clinical and Translational Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facn3.666","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acn3.666","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acn3.666","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acn3.666","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T11:56:07Z","timestamp":1694778967000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acn3.666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,31]]},"references-count":36,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1002\/acn3.666"],"URL":"https:\/\/doi.org\/10.1002\/acn3.666","archive":["Portico"],"relation":{},"ISSN":["2328-9503","2328-9503"],"issn-type":[{"value":"2328-9503","type":"print"},{"value":"2328-9503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,31]]},"assertion":[{"value":"2018-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}