Acute intractable vomiting: Do I belong somewhere else?

Abstract

Patients suffering from acute intractable vomiting are usually treated in the Gastroenterology department. The causes of acute intractable vomiting range from acute pancreatitis and acute intestinal obstruction to cardiac causes like acute myocardial infarction and neurological causes like posterior circulation stroke. However, most of the underlying causes of acute intractable vomiting also produce other telltale signs/symptoms. Rarely, isolated acute intractable vomiting may be the initial symptom of a recurrent neurological syndrome of neuromyelitis optica spectrum disorder (NMOSD). Not only can it be promptly treated if diagnosed correctly, but also a timely diagnosis may help in prevention of recurrent neurological deficits, which can sometimes be life threatening. We present three cases of NMOSD that presented with intractable vomiting and were treated in a Gastroenterology facility prior to their diagnosis.

Vomiting in Neuromyelitis Optica: An Atypical Presentation

“…This is consistent with the past cases reported in the literature [8,12]. Despite many cases being reported from the region of Asia, particularly many from India [11], the case in hand is the solitary case of NMO presenting with intractable vomiting to be reported from Pakistan and can be considered a stepping-stone for this under-reported subject.…”

“…Jin X et al reported 12 cases of NMO with a similar presentation, of which 83% were aquaporin-4 antibody positive [9], while another study reported 14 cases of NMO with similar initial manifestations as well [10]. More reports can be found in the literature from Asia, including cases from India and China [11,12]. Contrary to our case, intractable hiccups were also a prominent symptom of NMO in other cases [13].…”

“…The likely cause of initial manifestation of NMO with intractable vomiting, nausea and/or hiccups has been associated with a rather uncommon aspect of the disease called area postrema syndrome [11]. Area postrema syndrome is defined as an episode of hiccups or nausea and vomiting due to pathology in the region of area postrema, with no other known cause or explanation [15].…”