{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:09:49Z","timestamp":1772431789334,"version":"3.50.1"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>Neuromyelitis optica spectrum disorder (NMOSD) can affect autonomic centers in the dorsal medulla, but presentation with recurrent sinus arrest is extremely rare. We report a 71-year-old woman with 10 days of persistent hiccups and vomiting who developed repeated syncopal episodes. ECG monitoring revealed vomiting-induced bradycardia progressing to sinus arrest, and Holter monitoring showed nocturnal sinus pauses up to 40.6 s. Routine cardiac and neurological evaluations were unremarkable, but serum anti\u2013aquaporin-4 antibodies were markedly elevated, and brain MRI demonstrated a dorsal medullary lesion, confirming NMOSD with area postrema involvement. The patient was treated with intravenous immunoglobulin and high-dose methylprednisolone, resulting in complete resolution of vomiting and normalization of sinus node function. A temporary pacemaker was required acutely, and a permanent pacemaker was implanted before discharge. She remained stable on rituximab without relapse. This case underscores that severe vomiting-triggered sinus arrest may be an autonomic manifestation of NMOSD and is reversible with timely immunotherapy.<\/jats:p>","DOI":"10.3389\/fphys.2026.1732019","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T05:21:28Z","timestamp":1772428888000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Recurrent sinus arrest induced by repeated vomiting"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhongbiao","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Radiology, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yudong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Medical Simulation Center, Guilin Hospital of the Second Xiangya Hospital, CentralSouth University","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingxian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/S1474-4422(24)00077-2","article-title":"Safety and efficacy of inebilizumab for the treatment of neuromyelitis optica spectrum disorder: end-of-study results from the open-label period of the N-MOmentum trial","volume":"23","author":"Cree","year":"2024","journal-title":"Lancet Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s12883-022-02580-x","article-title":"Sick sinus syndrome as the initial manifestation of neuromyelitis optica spectrum disorder: a case report","volume":"22","author":"Hamaguchi","year":"2022","journal-title":"BMC Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"169","DOI":"10.7861\/clinmedicine.19-2-169","article-title":"Neuromyelitis optica spectrum disorders","volume":"19","author":"Huda","year":"2019","journal-title":"Clin. 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