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Raised ICP Vomiting — RACP Adult Medicine MCQ

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ModerateNeurologyRaised ICP VomitingRACP Adult Medicine

A 50-year-old man with a posterior fossa brain tumour presents with persistent vomiting and headache. He has papilloedema. CT confirms raised intracranial pressure with obstructive hydrocephalus. What is the most appropriate antiemetic?

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Correct answer: B — Dexamethasone

Vomiting from raised ICP (posterior fossa tumour with hydrocephalus) is mediated centrally. Dexamethasone reduces peritumoural oedema and is the most effective antiemetic for raised ICP-related vomiting. It also reduces ICP directly. Definitive management of the hydrocephalus (neurosurgical — EVD or shunt) is required. Cyclizine (antihistamine) is also useful for centrally mediated vomiting. Metoclopramide is less effective for central causes.

Reference: PCA – 2024 – Nausea/Vomiting; eTG 2024