Area postrema syndrome caused by medullary infarction

Area of Science:

• Neurology
• Gastroenterology

Background:

• Area postrema syndrome, characterized by nausea and vomiting, is a rare complication of ischemic stroke.
• Medullary infarction can affect the area postrema, a key chemoreceptor trigger zone.

Observation:

• A patient experienced persistent, intractable nausea and vomiting for over a month after a medullary infarction.
• Brain MRI confirmed an ischemic lesion in the lateral medulla.
• Initial antiemetic treatments (metoclopramide, ondansetron) were ineffective.

Findings:

• The patient's intractable nausea and vomiting resolved with the combined oral administration of domperidone and itopride, alongside continued intravenous metoclopramide and ondansetron.
• This case highlights a successful therapeutic strategy for a rare neurological complication.

Implications:

• This case suggests that a combination therapy including domperidone and itopride may be effective for managing persistent nausea and vomiting secondary to medullary infarction.
• Further research into the specific mechanisms and optimal treatment protocols for area postrema syndrome is warranted.