Isolated Vomiting due to a Unilateral Dorsal Vagal Complex Lesion

Emesis responsive to levetiracetam

“…Rarely, lesions situated in the dorsolateral medulla are associated with isolated central vomiting,1 presumably by involvement of the vomiting “pattern generator” of the dorsal vagal complex 2. Here we present a patient with this condition who responded dramatically to levetiracetam.…”

Intractable vomiting caused by vertebral artery compressing the medulla: A case report

“…[ 3 ] Sustained hiccups with vomiting or isolated spontaneous vomiting with negative gastrointestinal symptoms should prompt further workup, including neuroimaging, to search for a central cause. [ 1 4 ] The patient in our case was incidentally found to have dizziness and diplopia during the initial workup, but was not demonstrating positional vomiting or headaches, which would have prompted a neurological workup sooner. [ 3 ] The tortuous vertebral artery in this case was found on the diagnostic MRI/MRA of the head and neck obtained secondary to her history of breast cancer and new onset symptoms of diplopia and dizziness.…”

Gastrointestinal Dysfunction in Multiple Sclerosis and Related Conditions

“…In patients with PD, a decreased number of neurons producing substance P and 5-HT has been observed along with Lewy bodies in the DMV; these contribute to the rostral GI tract's hypomotility in PD. Mass lesions, 21 radiation injury, 22 stroke, 23 systemic lupus erythematosus (SLE), 24 and NMOSD all can produce a focal lesion in the DMV complex, and these lesions can cause intractable hiccupping and vomiting, which has been labeled the "area postrema syndrome. "…”

“…As noted above, lesions that affect the DMV can induce nausea, vomiting, and hiccupping. Up to 10% of NMOSD cases are affected in this manner 24,77,78 solely or as a prodrome of other neurological symptoms. The APS is one of the three core clinical manifestations in the NMOSD diagnostic criteria.…”