Abstract:We describe a 31-year-old man with clinically definite multiple sclerosis who presented with intractable hiccup for one month prior to admission. The responsible lesion was confirmed by magnetic resonance imaging to be a plaque in the ventral paramedian portion of the medulla oblongata.Resume: Hoquet incoercible du a une sclerose en plaques: visualisation d'une plaque medullaire par RMN. Nous decrivons le cas d'un homme de 31 ans, atteint d'une sclerose en plaques cliniquement certaine, qui a pr6sent6 un hoquet incoercible un mois avant son admission. L'imagerie par resonance magnetique a confirme' que la lesion en cause etait une plaque situee dans la portion param6diane ventrale du bulbe rachidien.Can. J. Neurol. Sci. 1994; 21: 271-272 Although multiple sclerosis (MS) is characterized by protean manifestations, intractable hiccup (IH) is rare and has been described only in isolated case reports. '" 3 We describe a patient with clinically definite MS presenting with IH who responded well to corticosteroid therapy. CASE REPORTA 31-year-old businessman experienced IH, vertigo and vomiting for two weeks in December 1987. Six weeks later, the patient developed transient episodes of double vision on left gaze and paroxysmal attacks of left facial numbness. Cranial nerve examination disclosed impaired left visual acuity, horizontal nystagmus on left gaze, hypesthesia and dysesthesia in the left face and ipsilateral neurosensory hearing impairment. Additional neurologic findings were mild paraparesis with brisk tendon reflexes, right dysmetria and symmetrical sensory disturbance below the T |0 level bilaterally.Laboratory examinations were unremarkable, except that cerebrospinal fluid (CSF) study showed a slight mononuclear pleocytosis as well as mild protein elevation with 18% IgG. Pattern-shift visualevoked potentials (EP) revealed prolonged latencies bilaterally. Studies of short-latency somatosensory EP and brainstem auditory EP were compatible with intrinsic brainstem lesions. However, a cranial computed tomographic (CT) scan was unremarkable. In the following 4 years, he had one relapse and remission of the right hemiparesis and brachial monoparesthesia.He was readmitted to our hospital in September 1992 because of IH for about one month. The patient had 10 to 15 episodes of hiccup per day and each episode lasted minutes to hours. The hiccups could not be suppressed by Valsalva maneuver, vagal stimulation, or irritation of the uvula. Therapeutic trials with metoclopramide, chlorpromazine and diphenylhydantoin were all in vain. The patient also complained of episodic vomiting, easy choking, double vision, unsteady gait and a symmetrical ascending numbness and tight sensation up to the occipital region.On neurologic examination, slow saccadic movement on right gaze was present with concomitant horizontal nystagmus. Dysarthria, bilateral trigeminal hypesthesia, cerebellar dysmetria and diminished proprioception of all extremities were also noted. There was no motor weakness, but a generalized hyperref...
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