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Background: Gastroparesis has a number of etiologies. The main ones are secondary to a complication from diabetes mellitus, related to post vagotomy or post gastric surgical resections, or idiopathic when the etiology is unclear. Gastroparesis secondary to a demyelinating disease of the brain is unusual. Case presentation: A 22-year-old woman was referred for acute onset of intractable nausea and vomiting. She also had cerebellar deficits, dysphagia and paresthesias. Magnetic resonance imaging (MRI) of the brain revealed an isolated area of demyelination in the medullary region. Another 24year-old woman had a similar presentation with right hemiplegia and MRI of the brain revealed a distal medullary region. Both these patients had an abnormal gastric emptying test. Gastroparesis and neurological deficits improved with intravenous corticosteroids. While the former patient has had no further recurrences, the latter patient developed multiple sclerosis within three months of presentation. Conclusion: A demyelinating disease is a rare cause gastropareis, but should be suspected when symptoms of gastroparesis are associated with neurological deficits. MRI might help in the diagnosis and intravenous coriticosteroids can address the underlying disease process and improve gastric emptying, especially when used early during the course of the disease. Background Gastroparesis is a condition characterized by evidence of gastric retention in the absence of any mechanical obstruction. Symptoms usually include nausea, vomiting, post prandial fullness, and abdominal pain [1]. Diabetes Mellitus is the commonest cause of gastroparesis, other etiologies include idiopathic, and post surgical usually secondary to a vagotomy [2]. A primary neurological basis for gastroparesis is unusual. We present a series of two patients with gastroparesis due to a demyelinating disease. Case presentation Case 1 A 22-year old woman was seen in the emergency department with acute onset of intractable nausea and vomiting. Nausea and vomiting were predominantly post-prandial and seemed to respond partially to metoclopramide. Over the next few weeks she also developed dysphagia, blurry vision, paresthesias involving her lower and upper extremities, and problems with balance. Physical exam was significant for nystagmus on lateral gaze, quadriparesis, absent deep tendon reflexes in all four extremities, a negative plantar reflex, and a positive finger-nose test. No history of vertigo was obtained, cranial nerves were intact, Published: 31 January 2007 BMC Gastroenterology 2007, 7:3 doi:10.1186/1471-230X-7-3 Received: 15 September 2006 Accepted: 31 January 2007 This article is available from: http://www.biomedcentral.com/1471-230X/7/3 © 2007 Reddymasu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.