Does a stroke cause vomiting

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The Relationship Between Stroke and Vomiting

Introduction: Stroke and Vomiting Symptoms

Vomiting is a common symptom observed in stroke patients and can serve as an important clinical indicator. Understanding the relationship between stroke and vomiting can aid in early diagnosis and improve patient outcomes.

Prevalence of Vomiting in Different Types of Stroke

Research indicates that vomiting is a frequent symptom in stroke patients, though its prevalence varies by stroke type. A study involving 1968 stroke patients found that vomiting occurred in 14.5% of all cases. When broken down by stroke type, vomiting was observed in 8.7% of cerebral infarction (CI) cases, 23.7% of cerebral hemorrhage (CH) cases, and 36.8% of subarachnoid hemorrhage (SAH) cases. This data suggests that vomiting is more common in hemorrhagic strokes compared to ischemic strokes.

Vomiting as a Predictor of Stroke Outcome

Vomiting at the onset of a stroke has been linked to higher mortality rates. Patients who experienced vomiting had a significantly higher risk of death compared to those who did not, with hazard ratios (HR) indicating a strong correlation across different stroke types. This makes vomiting a critical early predictor of stroke outcomes.

Vomiting in Ischemic Brainstem Strokes

In ischemic strokes involving the lower brainstem, vomiting can be a prominent symptom even when other neurological signs are minimal or absent. This can lead to misdiagnosis as a gastrointestinal disorder. Recognizing this pattern is crucial for accurate diagnosis and treatment.

Cyclic Vomiting Syndrome Post-Stroke

Cyclic vomiting syndrome (CVS), characterized by recurrent episodes of vomiting, can develop after a stroke. A case study reported a 69-year-old woman who developed CVS following a left cerebral infarct. This condition was managed effectively with imipramine hydrochloride. Although rare, CVS should be considered in post-stroke patients presenting with recurrent vomiting.

Area Postrema Syndrome and Stroke

The area postrema (AP) in the dorsal medulla is a key region involved in vomiting. Lesions in this area can lead to area postrema syndrome (APS), characterized by intractable nausea, vomiting, and hiccups. APS can occur due to ischemic stroke, particularly in the cerebellum and brainstem. Recognizing APS in stroke patients is essential for appropriate management and avoiding unnecessary diagnostic procedures.

Acute Cerebellar Stroke and Vomiting

Acute cerebellar strokes can cause severe vertigo, nausea, and vomiting. A case involving a U.S. Air Force pilot highlighted the potential for misdiagnosis and the importance of considering stroke in patients with acute onset of these symptoms. Proper diagnosis is critical to prevent severe consequences, especially in high-risk professions.

Perioperative Nausea and Vomiting Protocols

Implementing standardized perioperative nausea and vomiting protocols can reduce the incidence of perioperative strokes in patients undergoing neurosurgical procedures. A study on children and young adults with moyamoya disease undergoing indirect bypass surgery showed a significant reduction in perioperative strokes following the implementation of such a protocol. This underscores the importance of managing vomiting to improve surgical outcomes.

Conclusion

Vomiting is a significant symptom in stroke patients, varying in prevalence across different types of strokes. It serves as an important predictor of stroke outcomes and can indicate specific conditions like APS and CVS. Proper recognition and management of vomiting in stroke patients are crucial for accurate diagnosis, effective treatment, and improved patient outcomes.