Ictus emeticus (ictal vomiting)

Vomiting is rarely the main ictal manifestation of epilepsy, and it is likely associated with more than one type of epilepsy. Its possible mechanism involves the spread of abnormal electrical activity through descending insular or limbic circuits. This report describes a child with difficult-to-control ictal vomiting arising from a left temporal epileptic focus. Ictus emeticus is a specific epileptic presentation which can have a chronic, intractable nature requiring repetitive therapeutic trials with antiepileptic medications. In the patient described here, the disease posed a diagnostic dilemma in its early stages. The ictal electroencephalogram is crucial for the diagnosis.