Aungaroon G, Vawter-Lee M. Teaching Video NeuroImages: Ictal vomiting in a child. Neurology. 2018 Nov 6;91(19):e1836-e1837. https://n.neurology.org/content/91/19/e1836
A 22-month-old boy presented with repetitive vomiting. The vomiting was occasionally associated with behavioral arrest, right arm jerking, and rightward head deviation. Video EEG revealed ictal vomiting localized to the left temporal head region (video at link above). The MRI showed left hemisphere polymicrogyria, particularly in the left temporal lobe. The seizures remained intractable despite multiple antiepileptic medications (levetiracetam, oxcarbazepine, and lacosamide). Ictal vomiting is a rare seizure semiology with a few distinctive features. It is reported in 2.7% of children and hypothesized to be associated with insular cortex involvement during a seizure.