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Emesis is a persistent problem in patients with brain tumours, and can result from chemotherapy, radiation therapy or the tumour itself. 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.
A 78-year-old right-handed woman with a history of mild hypertension and hypothyroidism presented with several years of unsteady gait and falls, chronic headaches, and nausea and vomiting. Examination revealed bilateral end gaze horizontal nystagmus, sustained on left gaze, and a wide based unsteady gait. MRI scan revealed a lesion in the fourth ventricle adjacent to the posterior aspect of the lower medulla. A subtotal resection of the lesion was performed in 2003; pathology revealed a choroid plexus papilloma. Although her nausea and vomiting initially subsided after surgery, symptoms returned 3 years later. She experiences a short period of discomfort and not feeling “right” rather than nausea, after which vomiting occurs. Most of the time she is unable to get to the restroom. Although vomiting occurs more frequently during the day, these episodes occasionally occur during the night, awakening her from sleep. There is no definite association with …
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