Yes, Central Causes of Vertigo Absolutely Cause Vomiting
Central causes of vertigo, including stroke, multiple sclerosis, and brain tumors, definitively cause nausea and vomiting as core clinical features. 1
Clinical Evidence for Vomiting in Central Vertigo
Stroke and Ischemia
- Stroke/ischemia presents with vertigo accompanied by nausea and vomiting, along with severe imbalance. 1
- Central vestibular lesions affecting the pons, medulla, or cerebellum cause vertigo, nausea, vomiting, severe ataxia, and multidirectional nystagmus that is not suppressed by optic fixation. 2
- Vertigo, nausea, and vomiting, along with nystagmus, represent classic symptoms of posterior fossa stroke due to vertebrobasilar system involvement. 3
Multiple Sclerosis
- Multiple sclerosis is listed among central causes that produce vertigo with associated autonomic symptoms. 1, 4
- Central nervous system pathology from demyelinating diseases like MS causes vertigo that can be accompanied by the same visceral autonomic symptoms (including vomiting) seen in other vestibular disorders. 5
Brain Tumors
- Tumors of the posterior fossa are recognized as central causes of dizziness and vertigo. 2
- Intracranial tumors affecting vestibular pathways produce vertigo with associated nausea and vomiting as part of the central vestibular syndrome. 4, 5
Mechanism of Vomiting in Central Vertigo
- Vertigo is often accompanied by visceral autonomic symptoms including pallor, diaphoresis, nausea, and vomiting, regardless of whether the cause is central or peripheral. 6
- The vestibular system's connections to autonomic centers in the brainstem explain why both peripheral and central vestibular disorders trigger nausea and vomiting. 6
- Central vestibular lesions can actually produce more severe nausea and vomiting than some peripheral causes due to direct involvement of brainstem autonomic nuclei. 2
Critical Clinical Distinction
The presence or absence of vomiting does NOT distinguish central from peripheral vertigo—both cause vomiting. 1, 2
What Actually Distinguishes Central from Peripheral:
- Neurologic signs: Dysarthria, dysmetria, dysphagia, sensory or motor loss, or Horner's syndrome indicate central pathology. 4
- Nystagmus patterns: Direction-changing nystagmus without head position changes, downbeating nystagmus without torsional component, or direction-switching nystagmus (beats right with right gaze, left with left gaze) are red flags for central causes. 4
- Hearing loss: Usually absent in stroke but present in peripheral causes like Ménière's disease. 1
- Duration and permanence: Central insults are often permanent and do not fluctuate, unlike peripheral causes. 1
Common Pitfall to Avoid
Do not assume that severe nausea and vomiting indicate a benign peripheral cause—this is a dangerous misconception. 4, 3
- 75-80% of stroke-related acute vestibular syndrome patients have no focal neurologic deficits, making stroke easy to miss if you rely solely on the presence of vomiting or absence of obvious neurologic signs. 4
- In one series, 10% of cerebellar strokes presented identically to peripheral vestibular processes. 4