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At the onset of ischemic strokes involving the lower brainstem, vomiting may be prominent when dizziness and other neurologic abnormalities are minimal or absent. Errors in interpretation may result in the misdiagnosis of a gastrointestinal disorder. The stroke literature does not clearly refer to this clinical point. The present note draws attention to the phenomenon both for practical diagnostic reasons and to illustrate a distinct form of vestibular vomiting.
Case 1.
A 52-year-old hypertensive, diabetic man with a history of myocardial infarction awakened at 1 AM with nausea and vomiting. He vomited hourly until arrival at the Emergency Department at 8 AM. He had no history of dizziness, headache, abdominal pain, or diarrhea. On examination the man was alert and afebrile; his abdomen felt normal; and his neurologic status was intact except for peripheral neuropathy. His blood pressure was 220/118 mm Hg. Blood chemistry test results …
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