Cyclical Vomiting Associated with a Focal Lesion of the Area Postrema Successfully Managed with Medical Marijuana (P3.9-053)

Background: Focal lesions of the area postrema are a rarely reported cause of cyclical vomiting and present a diagnostic challenge to both clinician and radiologist. While cannabinoids have been shown to bind central CB1/2 receptors and reduce chemotherapy-associated emesis, their role in other vomiting disorders is less established.

Design/Methods: A 30-year-old female presented to the neurology clinic with a 15-year history of cyclical vomiting. She experienced 20 symptomatic days a month, during which she would vomit up to 8 times over a period of 5–6 hours. Nasal sumatriptan provided only minimal relief, and she was frequently hospitalized during these episodes for intravenous hydration. An extensive workup at multiple institutions failed to identify a cause for her vomiting. The neurological exam was unremarkable.

An MRI of the brain was ordered to assess intracranial pathology. The MRI was initially read as normal; however, on review, a small central hypointensity at the caudal end of the fourth ventricle consistent with a focal lesion of the area postrema was noted. A repeat MRI four months later confirmed the finding.

Results: Given a presumed central etiology for the vomiting and the limited success of conventional therapy, a trial of medical marijuana was recommended. The patient was prescribed 10mg of 1:1 CBD:THC daily with 30mg CBD to be taken at the onset of vomiting episodes. On this regimen, the frequency of episodes was reduced to 7 times a month and the duration was reduced to 3–5 hours. There were no further hospitalizations, and the patient reported significant improvement in quality of life.

Conclusions: This case of a rare focal lesion of the area postrema highlights the importance of investigating central neurological causes in patients with persistent unexplained vomiting, even in the presence of a normal neurological exam, and the utility of marijuana in managing this broad spectrum of disease.

Disclosure: Dr. Hirsch has nothing to disclose. Dr. Gierlich has nothing to disclose. Dr. Glants has nothing to disclose. Dr. Sheikh has nothing to disclose. Dr. Duran has nothing to disclose. Dr. Krishna has nothing to disclose.