The vomiting center may be directly or indirectly stimulated.
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“Central nervous system disease may directly stimulate the vomiting center, such as direct extension of inflammatory stimuli, hydrocephalus or space-occupying lesions. The vomiting center is stimulated indirectly via a humoral pathway by activating the chemoreceptor trigger zone located in the area postrema at the base of the fourth ventricle, an area devoid of a blood-brain barrier that allows exposure to chemical stimuli found in the circulation.”
-Johnny D. Hoskins, DVM, PhD, DACVIM
From Nausea, vomiting: First treat the underlying cause