Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory demyelinating disease of the central nervous system. It often presents as optic neuritis or transverse myelitis, and less commonly as area postrema syndrome or brainstem involvement. In our case, we admitted an 8.5-year-old gírl with a three-week history of intractable nausea, daily vomiting and frequent hiccups. After excluding gastrointestinal causes, a brain MRI showed hyperintensity ín the area postrema on T2/FLAIR sequences. The patient was subsequently referred to our neurology department, where the serum aquaporin-4 antibody test was mildly positive. Based on the clinical signs, serum antibody positivity and radiological findings consistent with the symptoms, we diagnosed aquaporin-4 antibody-mediated NMOSD and initiated high-dose steroid therapy. In conclusion, childhood-onset intractable vomiting and frequent hiccups, together with AQP4 IgG positivity and consistent radiological findings, are suggestive of NMOSD.  Kulcsszavak: pediatric NMOSD, neuromyelitis optica spectrum disorder, intractable nausea, vomiting