Treating Intractable Nausea and Vomiting in Cerebellar and Medullary Stroke

Cerebellar and medullary stroke can cause persistent nausea and vomiting that may be resistant to initial antiemetic monotherapy and interfere with oral intake and recovery. Evidence guiding management remains limited. We report a 48-year-old man with diabetes mellitus and acute-to-subacute infarcts involving the inferomedial right cerebellum and posterior right medulla who presented with 10 days of persistent nausea and vomiting accompanied by focal neurologic symptoms. Diabetic gastroparesis was considered, but abdominal imaging and gastric emptying scintigraphy did not support a contributory gastrointestinal cause. Ondansetron and metoclopramide provided only limited or temporary relief. Symptoms improved after sequential escalation to ondansetron, chlorpromazine, prochlorperazine, and amitriptyline; transdermal scopolamine was included in the discharge regimen. Nausea and vomiting were nearly resolved before discharge and fully resolved by three-month follow-up. Because multiple medications were introduced over a short interval and natural neurologic recovery may have contributed, the effect of any individual agent or combination cannot be determined. This case suggests that receptor-diverse pharmacotherapy may be considered when initial treatment fails while underscoring the need for further study of efficacy, safety, and medication sequencing.