Refractory central supratentorial hiccup partially relieved with vagus nerve stimulation

Supratentorial infarcts accompanying hiccup

“…On the other hand, a few cases with supratentorial cortical damage including the temporal lobe or insular cortex have been reported to experience intractable hiccups (van Durme et al, 2008;Jansen et al, 1990;Lee et al, 2011;Longatti et al, 2010;Marsot-Dupuch et al, 1995;Tiedt & Wenzel, 2013). We described four cases with hiccup caused by supratentorial subcortical infarcts, in addition to three cases with cortical infarcts that were in accordance with past studies.…”

“…We demonstrated that the culprit lesion in some patients with hiccup caused by acute ischemic stroke was partially attributable to supratentorial infarcts. We identified not only cortical infarcts including the insular cortex and temporal lobe, as previously reported to be associated with hiccup (van Durme et al, 2008;Jansen et al, 1990;Lee et al, 2011;Longatti et al, 2010;Marsot-Dupuch et al, 1995;Tiedt & Wenzel, 2013), but also supratentorial subcortical infarcts. Moreover, the right hemisphere was frequently damaged in this series.…”

“…Moreover, the right insula was implicated in the autonomic control of cardiac activity (Colivicchi, Bassi, Santini, & Caltagirone, 2004). In the literature, there were five cases with the right-sided, three with the left-sided, and one case with diffuse bilateral lesions among nine cases with hiccup associated the supratentorial injury (van Durme et al, 2008;Jansen et al, 1990;Lee et al, 2011;Longatti et al, 2010;Marsot-Dupuch et al, 1995;Tiedt & Wenzel, 2013). The predominance of the right-sided infarct in our study could be attributable to a chance finding; however, the importance of the right hemisphere about the pathogenesis of hiccup in stroke could not be ignored.…”

“…The main causes of hiccup can be classified as: central nervous system; psychiatric; metabolic; toxic and infectious; ear, nose, and throat disease; thoracic; and abdominal (Kahrilas & Shi, 1997;Launois et al, 1993;Marsot-Dupuch et al, 1995). Although the main culprit lesion in the central nervous system causing hiccup is thought to involve the brainstem, including the medulla oblongata or pons (al Deeb, Sharif, al Moutaery, & Biary, 1991;Kim, 2003;Kobayashi et al, 2009;Kumar & Dromerick, 1998;Liu, Fuh, & Wang, 2008;Mattana, Mattana, & Roxo, 2010;Musumeci, Cristofori, & Bricolo, 2000;Park et al, 2005), a few cases with persistent or intractable hiccups caused by damage to the supratentorial cortex have been reported (van Durme, Idema, & van Guldener, 2008;Jansen, Joosten, & Vingerhoets, 1990;Lee, Pritchard, & Weiner, 2011;Longatti, Basaldella, Moro, Ciccarino, & Franzini, 2010;Marsot-Dupuch et al, 1995;Tiedt & Wenzel, 2013). However, the characteristics of patients showing hiccups due to supratentorial lesions have not yet been fully elucidated.…”

The Role of Serotonin in Singultus: A Review

“…While usually effective in terminating bouts of acute hiccup, they are mostly ineffective in cases of hiccupping that have been present for an extended period, probably due to insufficiently sustained vagus nerve activation (Petroianu, 2015). The successful use of vagus nerve electrical stimulation for chronic intractable hiccups has been reported (Payne et al, 2005;Longatti et al, 2010) as have been failures of this approach (Grewal et al, 2018). The rationale for stimulating the left vagus nerve is that it innervates the AV node of the heart so as to have less of an effect on heart rate than the right vagus, which innervates the SA node (Carreno and Frazer, 2017).…”