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Ictus emeticus

An electroclinical analysis

From the Section of Epilepsy and Clinical Neurophysiology (Drs. Kramer, Luders, Goldstick, Dinner, Morris, Lesser, and Wyllie), Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.

We report 31 episodes of ictal vomiting in nine patients, documented by simultaneous video and EEG recordings. In four patients, chronically implanted subdural electrode arrays recorded the event. Only one patient showed "projectile" vomiting. Amnesia for the episode occurred in eight of the nine patients. Interictal epileptiform abnormalities were maxmal in the right temporal region in seven patients and bitemporal in two. Ictal epileptiform abnormalities were lateralized to the right hemisphere and involved temporal lobe structures in all patients. Three of four patients recorded with subdural electrode arrays were seizure-free following right temporal lobectomy, and the fourth continues to have ictus emeticus at a reduced rate. The consistent right hemisphere lateralization of seizures in this series corroborates with earlier reports documenting right-sided lateralization in four of five previous cases. Two features that help delineate paroxysmal vomiting as an ictal event are (1) patient unawareness of vomiting and (2) its association with other ictal phenomena.

Address correspondence and reprint requests to Dr. Ronald E. Kramer, Oregon Comprehensive Epilepsy Program, Good Samaritan Hospital and Medical Center, Portland, OR 97210.

Received June 9, 1987. Accepted for publication in final form November 16,1987.

Presented in part at the thirty-eighth annual meeting of the American Academy of Neurology, New Orleans, LA, April 1986.

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