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Rate ePoster

Neurological Rehabilitation

Low-Dose Olanzapine for Severe Intractable Nausea and Vomiting in patients with Neurofibromatosis Type 2 (NF2) and Vertigo After a Cerebellar Stroke: A Report of Two Cases

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Ivani Proano, DO

    Resident Physician
    Rutgers New Jersey Medical School PM&R Program
    Newark, New Jersey

    • Co-Author(s)

  • IK

    Isaac Kim, DO

    Resident
    Rutgers New Jersey Medical School PM&R Program
    West orange, New Jersey

  • AG

    Adrien Golocovsky, MD

    Resident Physician
    Rutgers New Jersey Medical School PM&R Program
    Newark, New Jersey

  • MM

    Manuela Morales-Rodriguez, NP

    Nurse Practitioner
    Rutgers New Jersey Medical School PM&R Program
    Dover, New Jersey

  • RB

    Radhika Bapineedu, MD

    Physician- Brain Injury medicine
    Kessler Institute for Rehabilitation - West Orange
    Franklin Lakes, New Jersey

  • NJ

    Neil Jasey, MD

    Medical Director
    Kessler Institute for Rehabilitation - West Orange
    Montclair, New Jersey

  • EA

    Eric Altschuler, MD, PhD

    Physiatrist
    Kessler Institute for Rehabiliation
    West Orange, New Jersey

Disclosure(s):
Ivani Proano, DO: No financial relationships to disclose
Case Diagnosis: Case 1: Neurofibromatosis Type 2 (NF2); Case 2: Cerebellar CVA.

Case Description or Program Description: Case 1: 32-year-old female with NF2 presented with progressive left-sided hearing loss over five months. MRI revealed bilateral vestibular schwannomas, left greater than right, with significant brainstem compression. She underwent elective retrosigmoid decompression of the left internal auditory canal (IAC) schwannoma, EVD placement, and craniectomy. Then she was transferred to acute inpatient rehabilitation (AIR), but daily nausea and vomiting unresponsive to ondansetron significantly interfered with therapy.

Case 2: A 66-year-old female with vascular risk factors presented with acute-onset dizziness, imbalance, and persistent nausea and vomiting. Initial head CT was unremarkable. MRI on ACHD 2 revealed a small acute left cerebellar infarct. She exhibited dynamic and postural instability, poor tolerance to positional changes, and limited ability to maintain visual fixation during vestibular testing. Despite treatment with meclizine, her symptoms persisted.

Setting: AIR Hospital

Assessment/Results: Case 1: Olanzapine 2.5mg nightly (off label use) was initiated on AIR day (AIRD) 13, resulting in a significant dramatic reduction in nausea and vomiting, with sustained symptom relief for the remainder of her rehabilitation stay.
Case 2: Olanzapine 2.5mg nightly (off label use) was initiated on AIRD 3, resulting in marked daily improvement. By AIRD 9, nystagmus had resolved, and by AIRD 10, vertigo had completely subsided

Discussion (relevance): Randomized Control Trials (RTCs) have established olanzapine as an effective rescue medication for chemotherapy-induced nausea and vomiting (CINV). Given its efficacy in this setting, we hypothesized its potential benefit in non-CINV as seen in Case 1. A porpos Case 2, a recent paper demonstrated olanzapine's effectiveness for vertigo in patients with lateral medullary stroke and TBI. Our findings suggest that low-dose olanzapine may offer a promising therapeutic option for refractory vestibular symptoms in these patient populations.

Conclusions: RCTS of olanzapine for non-CINV and vertigo due to CVA is warranted.