Profound Gastroparesis after Bilateral Posterior Inferior Cerebellar Artery Territory Infarcts (P01.030)

Abstract

Objective: To describe a case of acute gastroparesis as a result of medullary infarction. Background Function of the gastrointestinal system is partially dependent upon the integrity of the lower brain stem. While dysphagia commonly results from strokes of varying locations, acute dysfunction of other segments of the alimentary canal from stroke is not a well-described phenomenon. Design/Methods: Case report. Results: A 65 year old man with a history of diabetes mellitus without previous gastrointestinal difficulty presented with sudden onset vertigo, nausea, vomiting, a left Horner9s syndrome and hemiataxia, as well as gait ataxia. Magnetic resonance imaging (MRI) revealed an acute infarction in the midline cerebellum bilaterally and the left posterior caudal medulla, all within the right and left posterior inferior cerebellar artery (PICA) territories. Over the following week, the persistent nausea, vomiting, and vertigo gave way to severe nausea and vomiting exclusively after eating, accompanied by instantaneous satiety. Brain imaging demonstrated acute infarction of the midline cerebellum bilaterally and the left posterior caudal medulla. Serial cranial CT scans revealed minimal changes; a contrast-enhanced abdominal CT and endoscopy showed severe gastric distention but no anatomical obstruction of the gut. A gastric emptying study demonstrated 99% retention of the radiolabled meal on serial scintigraphy after 2, 3, and 4 hours post-ingestion, with minimal activity seen in the duodenum, consistent with severe gastroparesis. His symptoms were refractory to medical management, and he required a jejunostomy tube for 8 weeks as his oral intake gradually improved. Conclusions: Acute, isolated gastroparesis without gastrointestinal pathology can result from medullary infarctions. A possible explanation may be infarction or edema particularly affecting the pars centralis of the nucleus of the tractus solitarius. Preexisting diabetes mellitus may also have been a predisposing factor. Disclosure: Dr. Liff has received personal compensation for activities with E-Rewards Medical. Dr. Labovitz has nothing to disclose. Dr. Robbins has nothing to disclose.