Is vomiting after a stroke normal

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Vomiting After a Stroke: Understanding Its Prevalence and Implications

Prevalence of Vomiting in Stroke Patients

Vomiting is a relatively common symptom among stroke patients, though its prevalence varies depending on the type of stroke. A study examining stroke patients in the Kyoto prefecture found that vomiting occurred in 14.5% of all stroke 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 indicates that vomiting is more prevalent in hemorrhagic strokes compared to ischemic strokes.

Vomiting as a Predictor of Stroke Outcome

Vomiting at the onset of a stroke can be a significant predictor of mortality. The same study from Kyoto revealed that patients who experienced vomiting had a higher risk of death compared to those who did not. The hazard ratios (HR) for death were significantly elevated across all types of strokes: 5.27 for CI, 2.82 for CH, and 5.07 for SAH. This suggests that vomiting is not only a common symptom but also an important clinical indicator of stroke severity and prognosis.

Vomiting in Specific Stroke Types

Ischemic Brainstem Strokes

In ischemic strokes involving the lower brainstem, vomiting can be particularly prominent even when other symptoms like dizziness and neurological abnormalities are minimal or absent. This can sometimes lead to misdiagnosis as a gastrointestinal disorder rather than a stroke. Recognizing this pattern is crucial for accurate and timely diagnosis.

Cyclic Vomiting Syndrome Post-Stroke

There are rare cases where patients develop cyclic vomiting syndrome (CVS) after a stroke. CVS is characterized by recurrent episodes of vomiting separated by symptom-free periods. One documented case involved a 69-year-old woman who developed CVS following a left cerebral infarct. Her condition was managed effectively with imipramine hydrochloride. This highlights the need for clinicians to consider CVS in post-stroke patients presenting with recurrent vomiting.

Implications for Clinical Practice

Diagnostic Considerations

Given the association between vomiting and stroke, it is essential for healthcare providers to consider stroke in the differential diagnosis when patients present with unexplained vomiting, especially if accompanied by other neurological signs. This is particularly important in cases of ischemic brainstem strokes where vomiting may be the predominant symptom.

Management and Prognosis

The presence of vomiting in stroke patients should prompt a thorough evaluation and possibly more aggressive management due to its association with higher mortality rates. Early recognition and treatment of vomiting can potentially improve outcomes.

Perioperative Protocols

In surgical contexts, such as revascularization surgery for moyamoya disease, implementing standardized perioperative nausea and vomiting protocols has been shown to reduce the incidence of perioperative strokes. This underscores the importance of managing vomiting not only as a symptom but also as a preventive measure against further complications.

Conclusion

Vomiting is a significant symptom in stroke patients, with its prevalence and implications varying by stroke type. It serves as an important predictor of stroke severity and mortality, necessitating prompt recognition and management. Clinicians should be aware of the potential for misdiagnosis and the need for comprehensive care protocols to mitigate associated risks.