Initial presentation with recurrent vomiting, hiccups, vision blurring, gait instability, and mild limb weakness. Psychiatric symptoms including depression, cognitive impairment, and hypersomnia in the second presentation. MRI findings included hyper-intense lesions in bilateral periventricular white matter and longitudinally extensive transverse myelitis. Positive for anti-AQP4 IgG and anti-NMDAR antibodies in serum and CSF. Here, AQP4 is linked to Cognitive impairment.