Intractable Hiccups Post Stroke: Case Report and Review of the Literature

Hiccups in neurocritical care

“…Investigation to rule out GERD is important and includes an upper gastrointestinal endoscopy, esophageal manometry, and a 24 hour-pH-impedance reflux study [61]. In patients where no organic cause can be found or those not responding to routine treatment, imaging studies like computed tomography scan and magnetic resonance imaging of head and neck are warranted [62]. Stepwise management protocol is given in flow diagram (Fig.…”

Persistent hiccup reflex activation as a complication of dental implant surgery: a case report

“…Regarding CNS-related causes, the change of the anticoagulant scheme in our patient determined a potential risk factor for acute cerebrovascular accidents of embolic origin [ 10 ], but brain imaging excluded both brain hemorrhages and ischemic lesions in the posterior fossa. Moreover, the presence of an isolated hiccup without any further neurological deficit did not strongly support the hypothesis of a cerebrovascular event, since most cases of lateral medullary infarctions present with multiple additional neurological symptoms, and sometimes even include non-specific ones, such as headache, nausea or neck pain [ 10 – 12 ]. In partial contrast with this affirmation, a case of isolated hiccup due to supratentorial brain infarct has been actually reported [ 13 ].…”

Intractable Hiccups Due to Posterior Inferior Cerebellar Artery Aneurysm

“… 1 Even more rare are lesions of the central nervous system that occur as the result of an insult to the “hiccup center” in the medulla oblongata. 6 Ischemia and mass effect from tumors such as cavernoma, ependymoma, or choroid plexus tumor have been described, occurring in higher incidences than aneurysms. 5 6 It is therefore prudent to exclude central nervous system lesions in patients presenting with IH utilizing contrast-enhanced MRI with MRA.…”

“… 6 Ischemia and mass effect from tumors such as cavernoma, ependymoma, or choroid plexus tumor have been described, occurring in higher incidences than aneurysms. 5 6 It is therefore prudent to exclude central nervous system lesions in patients presenting with IH utilizing contrast-enhanced MRI with MRA. 7 Given the propensity of aneurysms to thrombose, differentiation from a hemorrhagic mass may be difficult, and confirmation with cerebral angiography should be considered.…”

“…Treatment of IH should begin with vagal maneuvers such as breath holding, immersion in cold water, or application of supraorbital pressure. 6 Persistent hiccups indicate the use of pharmacologic agents such as chlorpromazine, metoclopramide, gabapentin, orphenadrine, or antidepressants. 10 Hiccups resistant to noninvasive treatment necessitates a search for an underling cause in which case the possibility of brainstem lesions, including aneurysms, should not be overlooked.…”