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Disorders of the central and autonomic nervous systems as a cause for emesis in infants
1Department of Neurology, Sunrise Hospital and Medical Center, Las Vegas, NV, USA.
Insights
Infant vomiting can signal serious neurological disorders, often involving the brainstem's vomiting center. Prompt diagnosis and treatment are crucial for managing these complex conditions.
Area of Science:
- Neurology
- Pediatrics
- Neuroscience
Background:
- Vomiting in infants frequently stems from underlying neurological conditions.
- The brainstem's nucleus tractus solitarius (NTS) acts as a central vomiting pattern generator.
- The NTS receives input from various brain regions, including the area postrema.
Purpose of the Study:
- To explore the diverse neurological origins of vomiting in infants.
- To elucidate the neural pathways involved in infant vomiting.
- To discuss the challenges in treating neurologically-induced vomiting.
Main Methods:
- Review of neurological disorders causing infant vomiting.
- Description of the central pattern generator for vomiting (NTS).
- Identification of afferent pathways to the NTS, such as the area postrema.
Main Results:
- Neurological disorders stimulate the NTS, triggering the vomiting reflex.
- The area postrema, a key afferent, can be affected by hydrocephalus, head injuries, and tumors.
- Migraine, epilepsy, and dysautonomia are other neurological causes of infant vomiting.
Conclusions:
- Vomiting in infants can indicate significant neurological dysfunction.
- Effective treatment often depends on the reversibility of the underlying neurological condition.
- Management of neurologically-induced vomiting can be challenging.
Abstract:
Vomiting in infants can be caused by a wide variety of neurological disorders. All involve stimulation of a central pattern generator for vomiting located in the brainstem, the nucleus tractus solitarius. This, in turn, projects to multiple motor nuclei involved in the vomiting reflex. The chemoreceptor trigger zone (the area postrema) in the floor of the fourth ventricle is a major afferent to the nucleus tractus solitarius that can be stimulated by pressure from hydrocephalus, closed head injuries, or tumors. Other neurological causes of vomiting discussed include migraine, epilepsy, and dysautonomia. The treatment of vomiting associated with nervous system disease may be very difficult unless the condition is acute and readily reversible.