Intractable hiccups and nausea as initial presenting symptoms have been reported in 43% of cases [4] of NMO patients, positive for anti-AQP4/NMO-IgG antibodies [5-7]. There is a “rim and rosette” pattern of immune complexes in the NMO lesion which is a result of complement activation at the site of the AQP4 protein. The gene discussed is AQP4; the disease is neuromyelitis optica.