- Projectile vomiting is most commonly seen in patients with elevated intracranial pressure (ICP) due to direct stimulation of the vomiting center in the medulla by increased pressure.
- This vomiting occurs without preceding nausea and is forceful, as intracranial hypertension triggers the emetic reflex through increased pressure on the brainstem.
- It is a characteristic clinical sign distinguishing central causes of vomiting from gastrointestinal causes, where bilious or feculent vomiting is more typical.
- Projectile vomiting in this context reflects raised ICP rather than gastrointestinal pathology.

Reference: Davidson’s Principles and Practice of Medicine, 23rd Edition, Chapter: Disorders of the Central Nervous System, Page 639.