{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T05:25:47Z","timestamp":1772256347981,"version":"3.50.1"},"reference-count":14,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,7,28]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>A 30-year-old woman presented with recurrent hiccups, vomiting and painful diminution of vision and gait instability for 1\u2009day. She had one-and-a-half syndrome, bilateral seventh cranial nerve paresis with bilateral symptomatic optic neuritis and left-sided ataxic haemiparesis. We described her disorder as the \u2018twenty syndrome\u2019 (1<jats:sup>1<\/jats:sup>\/<jats:sub>2<\/jats:sub>+7+7+2+2+\u00bd=20). MRI of her brain revealed demyelination predominantly in right posterolateral aspect of pons, medulla and bilateral optic nerves. Serum antiaquaporin-4 antibody came out positive. Thus, she was diagnosed as neuromyelitis optica spectrum disorder (NMOSD). She responded brilliantly to immunosuppressive therapy. This is the first ever reported case of the \u2018twenty syndrome\u2019 secondary to cerebral NMOSD.<\/jats:p>","DOI":"10.1136\/bcr-2020-234450","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T05:45:35Z","timestamp":1600062335000},"page":"e234450","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["\u2018Twenty syndrome\u2019 in neuromyelitis optica spectrum disorder"],"prefix":"10.1136","volume":"13","author":[{"given":"Ritwik","family":"Ghosh","sequence":"first","affiliation":[{"name":"General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Souvik","family":"Dubey","sequence":"additional","affiliation":[{"name":"Neuromedicine, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurology, Kolkata, West Bengal, 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