On more detailed examination he was found to have horizontal nystagmus to the right side.
An immediate CT of the head was ordered which showed a lesion in the cerebellum (see below):
The patient was immediately transferred to the ICU and started on steroids to decrease the edema and mass effect on the brain until he could be taken to the operating room to have this brain mass decompressed.
The initial pathology report indicated metastatic high grade carcinoma. CT of the chest/abdomen/pelvis showed a large 5.5 x 3.5 x 4.7 cm heterogeneous enhancing mass measuring 78 Hounsfield units along the left external iliac chain, suspicious for lymphadenopathy.
In the light of these findings, and the prior cancer history, the final diagnosis was metastatic esophageal adenocarcinoma.
Brain metastasis from esophageal cancer are rare, with only approximately 100 clinical case reported in the world literature. Metastatic spread likely occurs via Batson’s vertebral venous plexus, which provides communications between the esophagus and CNS.
So, thebottom line here is that even though gastroenteritis, GI obstruction and medication side effects might be the cause for most cases of nausea and vomiting one should always think about other causes including CNS lesions.