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Acta Neurochir (2008) 150:12071208 DOI 10.1007/s00701-008-0132-1
BRIEF REPORT OF A SPECIAL CASE
Intractable hiccups as a presenting symptom of Chiari I malformation
Ponniah Vanamoorthy & Prachi Kar &
Hemanshu Prabhakar
Received: 29 January 2008 /Accepted: 28 April 2008 / Published online: 29 October 2008 # Springer-Verlag 2008
AbstractIntroduction Hiccups as the only presenting symptom in neurosurgical practice is uncommon.
Case history We report a case of a 22-year-old man who was evaluated for a 9-month history of intractable hiccups. He was diagnosed with a case of Chiari malformation type I. Discussion Surgical decompression improved the symptoms of the patient. The cause and pathogenesis of hiccups are discussed.
Conclusion Chiari malformation should be considered in patients with intractable hiccups, who are otherwise asymptomatic for any neurological problems.
Keywords Hiccups . Neurological symptom .
Chiari malformation
Hiccups consist of brief bursts of intense inspiratory activity involving the diaphragm and the inspiratory intercostal muscles, with reciprocal inhibition of expiratory intercostals muscles, the sound and discomfort resulting from glottic closure immediately after the onset of diaphragmatic contraction [5]. Most episodes of hiccups are self-limited, but prolonged or intractable hiccupping should prompt a search for a structural or functional causegastro intestinal, metabolic, endocrine, neurologic, or psychogenic. Neurogenic hiccups may result from structural or functional disturbances of the medulla (affecting the region of vagal nuclei and nucleus tractus solitarus) or of afferent and efferent nerve to the respiratory muscles [2]. Neurogenic
hiccup, however, seldom occurs in isolation, and associated brainstem or long tract signs are usually evident [4]. We report of a rare case of persistent intractable hiccups as the presenting symptom of syringomyelia associated with Chiari I malformation.
Case history
A 22-year-old man, weighing 65 kg, was evaluated for a 9-month history of intractable hiccups. He suffered repeated episodes of hiccups every third or fourth day, each episode lasting 18 to 24 h then subsiding spontaneously. Along with hiccups, he complained of tingling and paresthaesia in...