Images in Clinical Medicine
Vomiting of Neurologic Origin
N Engl J Med 2001; 345:33July 5, 2001
- Article
Figure 1 A 25-year-old man had a seven-month history of repeated, unprovoked, sudden vomiting without accompanying headache or any other neurologic or gastrointestinal symptoms. Vomiting had occurred daily in the previous two months. The results of a neurologic and general examination were normal, and there was no papilledema. A contrast-enhanced T1-weighted sagittal magnetic resonance image of the brain showed an intensely enhancing mass in the inferior region of the fourth ventricle, with mild ventricular enlargement (arrow). Other images showed focal invasion of the brain stem with moderate edema. The mass — a choroid-plexus carcinoma — was removed surgically, and there were no further episodes of vomiting. The patient remained free of disease 20 months after surgery; he was subsequently lost to follow-up.
Vomiting is under the control of two functionally distinct medullary centers: the vomiting center in the dorsal portion of the lateral reticular formation and the chemoreceptor trigger zone in the area postrema of the floor of the fourth ventricle. Vomiting in this patient probably resulted from compression of one or both centers by the tumor. The prognosis of a choroid-plexus carcinoma is favorable when the tumor can be completely resected.
Juan C. García-Moncó, M.D.
Jose A. Larena, M.D.
Hospital de Galdacano, 48960 Galdacano, Vizcaya, Spain
