Stroke And Vomiting: Is There A Link?

Vomiting is an uncommon but possible symptom of a stroke. It is estimated that around 14.5% of stroke patients experience vomiting, with the rate depending on the type of stroke. For instance, vomiting is observed in 8.7% of cerebral infarction cases, 23.7% of cerebral haemorrhage cases, and 36.8% of subarachnoid haemorrhage cases. The occurrence of vomiting during a stroke may be due to damage to certain areas of the brain or disruptions in the vestibular system. It is recommended to seek immediate medical attention if vomiting is suspected to be a symptom of a stroke, as persistent vomiting can lead to dehydration and negatively impact post-stroke recovery.

Vomiting is a warning sign of stroke

Vomiting is an uncommon but potential warning sign of stroke, and it is recommended that you seek immediate medical attention if you experience this symptom. While it is not one of the most well-known indicators of a stroke, it is important to be aware that sudden vomiting could be a sign of this life-threatening condition.

A stroke occurs when the supply of blood to the brain is cut off, typically due to a blood clot or a burst blood vessel. The most common signs of a stroke are easily remembered using the acronym FAST:

• Face – the face may be drooping on one side, with the person unable to smile, and their mouth or eye may have dropped.
• Arms – the person may not be able to lift both arms due to weakness or numbness in one arm.
• Speech – their speech may be slurred or difficult to understand, or they may be unable to speak at all.
• Time – if you observe any of these signs, it is time to call an ambulance immediately.

However, there are other warning signs that can also indicate a stroke, including sudden vomiting or nausea. This is an uncommon symptom, but it is important to be aware of it and to seek medical attention if you experience it. Other less common signs include vision changes, loss of coordination, dizziness, severe headaches, extreme fatigue, and numbness or tingling on one side of the body.

If you or someone you know is experiencing vomiting along with any of the other symptoms mentioned, it is crucial to act quickly and seek medical help. Stroke is a medical emergency that requires prompt attention to improve the chances of a positive outcome.

In addition to being a warning sign of an ongoing stroke, vomiting can also be a symptom that occurs after a stroke. This is known as post-stroke nausea and vomiting (PSNV) and can be caused by certain types of strokes, changes in brain chemicals and hormones, medications used to treat stroke, cyclic vomiting syndrome, vestibular disorders, or visual or oculomotor dysfunction. It is important to recognise and treat PSNV as it can lead to dehydration and negatively impact the recovery process.

Post-stroke vomiting could be a side effect of medication

Yes, vomiting is one of the most common symptoms in stroke patients. According to a study, vomiting was observed in 14.5% of all stroke patients. However, vomiting is more common in certain types of strokes. For instance, vomiting was observed in 23.7% of cerebral haemorrhage cases and 36.8% of subarachnoid haemorrhage cases.

Post-stroke nausea and vomiting could be a side effect of the medication used to treat stroke symptoms. It is important to talk to your doctor if you are experiencing an increase in nausea or vomiting. Your doctor may be able to prescribe you other medications to relieve the symptoms or change your medication. Additionally, medication management can help prevent nausea and vomiting.

Other Causes of Post-Stroke Vomiting

• Certain strokes, such as cerebellar strokes, can cause disruption to the vestibular system, which can lead to nausea and vomiting, as well as poor balance, dizziness, and impaired gait.
• Changes in brain chemicals and hormones: After a stroke, there is a disruption in the communication between the brain and gut, which can cause an increase in nausea.
• Cyclic Vomiting Syndrome: This is characterised by recurrent episodes of vomiting and may be caused by a dysfunction in the gut-brain connection.
• Vestibular Disorders: When the vestibular system is impacted by a stroke, it can cause nausea and vomiting, along with poor balance and impaired gait.
• Visual or oculomotor dysfunction: Changes in vision following a stroke, such as blurred vision or double vision, can also make some survivors feel nauseous.
• Onset of Another Stroke: Continuous vomiting can be a warning sign of another stroke, although it is not exceptionally common.

Vomiting can be caused by changes in brain chemicals and hormones

The brainstem is a key player in the vomiting response, with the dorsal vagal complex in the brainstem coordinating the emetic reflex. This complex includes the area postrema, the nucleus of the solitary tract, and the dorsal motor nucleus of the vagus. The area postrema and the nucleus of the solitary tract are particularly important as they lack a blood-brain barrier, allowing them to respond quickly to circulating and systemic stimuli.

The endocrine system also plays a role in nausea and vomiting. "Stress hormones", such as adrenocorticotropic hormone, cortisol, and antidiuretic hormone, are released during motion sickness. These hormones are also released during acute nausea, with plasma levels correlating to the intensity of nausea symptoms.

Neurotransmitters, such as serotonin and substance P, are also involved in the vomiting response. Serotonin is released from enterochromaffin cells in the gastrointestinal tract and acts on serotonin 3 (5-HT3) receptors located on vagal afferents and in the brainstem. Substance P is released from enterochromaffin cells and acts on neurokinin 1 (NK1) receptors, also located on vagal afferents and in the brainstem.

Changes in brain chemicals and hormones can trigger the vomiting response through their actions on these various receptors and pathways in the brain and gut.

Persistent vomiting after a stroke can cause dehydration

Persistent vomiting after a stroke should be treated as a medical emergency. This is because vomiting can cause the body to lose fluids and nutrients rapidly, leading to dehydration and malnutrition, which can cause a person's health to deteriorate quickly. Dehydration can cause serious problems with post-stroke recovery, including increased fatigue, dry mouth, muscle tightness, headaches, and dizziness. Therefore, it is essential to seek medical attention promptly and not attempt to self-diagnose or self-treat.

Hospitalization is often required for persistent vomiting after a stroke to replenish fluids and provide essential nutrients. During hospitalization, a medical team may perform various tests to diagnose any underlying conditions and determine the best course of treatment.

There are several possible causes of vomiting after a stroke, each requiring separate treatment. It is important to monitor the frequency and circumstances of vomiting episodes to help accurately determine the cause. Some possible causes include:

• Cyclic vomiting syndrome: This condition is characterized by recurrent episodes of stereotyped vomiting separated by symptom-free periods. It is believed to be caused by a dysfunction in the gut-brain connection.
• Side effects from medication: Certain medications can cause vomiting, especially when taken on an empty stomach.
• Onset of another stroke: Continuous vomiting can be a warning sign of another stroke, especially with hemorrhagic strokes.
• Damage to certain areas of the brain: Strokes that impact specific areas of the brain, such as cerebellar strokes, can cause nausea and vomiting, as well as poor balance, dizziness, and impaired gait.
• Vestibular disorders: When the vestibular system is affected by a stroke, it can lead to nausea and vomiting, as well as balance issues and impaired gait.

To treat vomiting after a stroke, medical professionals may prescribe medications such as tricyclic antidepressants, anti-seizure medications, or pharmacological treatments for vestibular dysfunction and vertigo. Adjusting problematic medications that list vomiting as a side effect may also be necessary. Vestibular rehabilitation exercises can help retrain the brain and body to regulate the sense of equilibrium, reducing nausea and vomiting.

Hemorrhagic strokes can cause vomiting

Hemorrhagic Strokes and Vomiting

Vomiting is one of the most common symptoms in stroke patients. It is seen in 14.5% of all stroke patients, with 23.7% of those with cerebral haemorrhage experiencing vomiting.

A hemorrhagic stroke is a medical emergency and occurs when a ruptured blood vessel disrupts blood flow to the brain. This can happen within the brain or between the brain and the skull. There are two types of hemorrhagic strokes: intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). ICH is about three times more common than SAH and is typically more serious.

The symptoms of a hemorrhagic stroke vary depending on the cause and the part of the brain affected. They tend to appear without warning and worsen over 30 to 90 minutes. Symptoms include:

• Total or limited loss of consciousness
• Sudden and severe headache
• Weakness or numbness in the face, leg, or arm on one side of the body
• Problems with speech or swallowing
• Confusion or disorientation

Vomiting can be a symptom of a hemorrhagic stroke, with 23.7% of cerebral haemorrhage cases involving vomiting. It is also a common post-stroke symptom, with certain areas of the brain damaged by the stroke causing an increase in nausea and vomiting behaviour. This can be due to disruption to the vestibular system, changes in brain chemicals and hormones, or as a side effect of medication.

If vomiting occurs after a stroke, it is important to seek medical attention as it could be a sign of another stroke or dehydration, which can cause serious problems with post-stroke recovery.

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