Pediatric Area Postrema Cavernoma: Clinical Presentation With Hiccups and Vomiting

Cavernous malformations are vascular lesions that may occur throughout the central nervous system. Their occurrence in the medulla oblongata, particularly in the area postrema, is exceedingly rare. Given the role of the area postrema in emesis, lesions in this region may produce a distinctive clinical presentation dominated by vegetative symptoms, such as intractable hiccups and vomiting. Surgical excision can lead to rapid symptom relief but may leave residual neurological deficits due to the eloquence of the brainstem region. We report the case of a 16-year-old boy with acute onset of neck pain, occipital headaches, paresthesias of the lower limbs, persistent vomiting, and intractable hiccups. Brain magnetic resonance imaging (MRI) revealed an intra-axial lesion within the area postrema, slightly lateralized to the left, with hemorrhagic remodeling suggestive of a cavernous malformation. The patient underwent successful surgical resection, which confirmed the diagnosis. Postoperatively, the hiccups and vomiting resolved completely, although residual left-sided hypoesthesia persisted at three months. This case illustrates the importance of considering structural lesions, including cavernomas, in the differential diagnosis of intractable hiccups and vomiting. Early imaging and surgical management are crucial to achieve symptom relief and prevent further neurological deterioration.