Case report Intractable hiccups and syncope in multiple sclerosis

A patient with multiple sclerosis (MS) who developed intractable hiccups and syncope due to a cervical cord lesion is reported. Previous case reports of intractable hiccups occurring in MS have all been located in the medulla oblongata. Our patient is the first case with the responsible lesion in the cervical cord. The pathophysiological mechanism of the syncopal attacks in this case were thought to be same as that of cough syncope.     

顽固性呃逆与菌群失调及真菌二重感染的相关性及其临床意义

目的 探究顽固性呃逆与菌群失调及真菌二重感染的相关性.方法 对使用抗生素后发生顽固性呃逆的患者120例,首先均进行常规治疗,同时进行实验室真菌检查,根据真菌检查阳性与否分为A、B两组,其中真菌检查阳性组(A组)52例和真菌检查阴性组(B组)68例.对A组52例进行抗真菌药物治疗,根据抗生素是否继续使用再分A1、A2两组,其中继续抗生素加抗真菌药物治疗组(A1组)32例和停抗生素加抗真菌药物治疗组(A2组)20例;对B组68例再随机分为B1、B2两组,包括停抗生素加常规治疗组(B1组)34例和继续抗生素加抗真菌药物治疗组(B2组)34例.观察各组顽固性呃逆的疗效,以及各组之间的疗效对比,顽同性呃逆与抗生素、菌群失调及真菌二重感染的关系.结果 常规治疗均效果不好,抗生素只能使顽固性呃逆病情加重,抗真菌药物治疗起效快,效果好,治愈率高达95%左右,有效率达100%.结论 顽同性呃逆与使用抗生素引起的菌群失调及真菌二重感染有相关性,抗真菌药物治疗对终止顽固性呃逆疗效显著.     

Treatment of Refractory Hiccups with Amantadine

Persistent or intractable hiccups are not uncommon at the end of life, occurring in approximately 4% to 9% of patients, and can cause considerable suffering, including difficulties in eating, drinking, and speaking, insomnia, pain, fatigue, and depression. In palliative practice, the etiology of hiccups is often either unknown or untreatable, and empirical pharmacologic treatment is the norm. Unfortunately, many of the agents reported as effective for hiccups can cause undesirable sedation. The authors describe a patient with end-stage vascular dementia and a 4-year history of idiopathic intractable hiccups who responded dramatically to amantadine, a nonsedating dopamine agonist. The role of dopamine in hiccups is somewhat ambiguous and likely not central to their cause or treatment. Amantadine may be a reasonable option for patients with distressing hiccups who cannot tolerate a sedating agent.     

Diaphragm myoclonus followed by generalised atonia in a patient with trisomy 4p: unusual semiology in an unusual condition

In this report, we describe a female patient with trisomy 4p, a rare genetic condition, with unusual seizure semiology. The patient is one of the oldest reported survivors with this condition. This semiology was noted while she was being monitored by inpatient video telemetry. We observed a series of myoclonic shoulder jerks, followed by hiccup‐like episodes, and finally an atonic head drop. Corresponding ictal EEG showed semi‐rhythmic high‐amplitude slow waves with spikes superimposed over the frontotemporal areas. This semiology was confirmed as habitual by her parents. Subsequent hiccup‐like episodes had no EEG correlate, and the head drop was again associated with semi‐rhythmic high‐amplitude slow waves and superimposed spikes, more prominent over the right hemisphere. In addition, we review the several cases in which hiccups have been associated with seizures and how this may relate to the neural pathways involved in the pathophysiology of hiccups. We believe the ictal hiccup‐like episodes followed by atonia to be a seizure semiology that has not previously been documented. [Published with video sequence]     

Persistent hiccup: A rare presentation of COVID-19

BackgroundHiccups are involuntary diaphragmatic muscle contractions with early glottis closure terminating inspiration. They are classified into two types: acute (<48 hours) and persistent (>48 hours). COVID-19 is the defining health crisis of our generation. Although there are common symptoms of the disease (e.g. fever, cough), several atypical presentations have appeared as the pandemic has evolved. Here, we present a patient with COVID-19 presenting with fever, sore throat, and persistent hiccups.Methods and resultsA 48-year-old man presented to the hospital with a seven-day history of persistent hiccups, fever, and sore throat. Physical examination was unremarkable and abdominal ultrasound showed gaseous abdominal distension. Laboratory values were remarkable for elevated C-reactive protein, ferritin, and lactate dehydrogenase levels. Computed tomography of the chest showed bilateral subpleural areas of ground-glass attenuation and crazy-paving pattern. A COVID-19 test was positive, and hydroxychloroquine, oseltamivir, baclofen, and symptomatic treatment were initiated. The hiccups improved, and the patient was discharged home after ten days.ConclusionPhysicians should maintain a high level of suspicion and be aware of atypical presentations of COVID-19.     

Does (supra)gastric belching trigger recurrent hiccups?

Twenty-four hours multichannel intraesophageal impedance and pH monitoring in a patient who suffered from recurrent hiccups for more than a year revealed frequent supragastric belching and pathological oesophageal acid exposure. Furthermore, a temporal relationship between the start of a hiccup episode and gastric belching was observed. The data support the hypothesis that there is an association between supragastric belching, persistent recurrent hiccups and gastro-oesophageal reflux disease, and that gast...     

Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome.

BACKGROUND: Clinical symptoms and outcomes of uraemic patients ingesting star fruit are quite variable and may progress to death. The purpose of the present report was to discuss the neurotoxic effects of star fruit intoxication in uraemic patients and to present the efficacy of different therapeutic approaches. METHODS: We studied a total of 32 uraemic patients who had ingested star fruit. Before the intoxication episodes, 20 patients were on regular haemodialysis, eight were on peritoneal dialysis and four were not yet undergoing dialysis. Two patients were analysed retrospectively from their charts, 17 were directly monitored by our clinic and 13 were referred by physicians from many areas throughout the country, allowing us to follow their outcome from a distance. Intoxicated patients were given different therapeutic approaches (haemodialysis, peritoneal dialysis and supportive treatment), and their outcomes were analysed. RESULTS: The most common symptoms were persistent and intractable hiccups in 30 patients (93.75%), vomiting in 22 (68.7%), variable degrees of disturbed consciousness (mental confusion, psychomotor agitation) in 21 (65.6%), decreased muscle power, limb numbness, paresis, insomnia and paresthesias in 13 (40.6%) and seizures in seven (21.8%). Patients who were promptly treated with haemodialysis, including those with severe intoxication, recovered without sequelae. Patients with severe intoxication who were not treated or treated with peritoneal dialysis did not survive. CONCLUSIONS: Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. Peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue.     

Orofacial Dyskinesia and Intractable Hiccups in a Patient with Varicella-zoster Virus Encephalomyelitis

A 73-year-old Japanese man with diabetic complications presented with involuntary lip movements and long-lasting hiccups after developing zoster rash. Magnetic resonance imaging revealed lesions involving the medial temporal lobe and C1 level of the spinal cord. Varicella-zoster virus (VZV) encephalomyelitis was diagnosed. We considered attributing the orofacial dyskinesia, a very rare symptom of VZV central nervous system (CNS) complications, to the temporal lobe lesion. Although the culprit lesion for the hiccups was unclear, further examinations may have clarified this issue. As immunocompromised patients with herpes zoster may develop CNS complications with a wide variety of symptoms, special care is needed.     

胃复安足三里穴位注射治疗中枢性呃逆40例探讨

目的：分析胃复安足三里穴位注射治疗中枢性呃逆的临床疗效。方法：选取本院收治的40例中枢性呃逆患者临床资料,随机分为观察组与对照组,各20例。对照组取生理盐水注射,观察组实施胃复安足三里穴位注射治疗,对比两组患者临床治疗效果。结果：观察组起效时间为(6.03±4.21)h,明显短于对照组的(14.85±7.83)h,差异有统计学意义(P<0.05)。观察组呃逆频率积分明显低于对照组,差异有统计学意义 (P<0.05)。观察组总有效率为90.00%明显高于对照组的70.00%,差异有统计学意义(P<0.05)。观察组复发率为5.00%明显低于对照组的20.00%,差异有统计学意义 (P<0.05)。结论：胃复安足三里穴位注射治疗中枢性呃逆,疗效较高,有利于改善患者临床症状,促进病情康复,降低疾病复发率,值得临床推广。     

Persistent Hiccups in Posterior Circulation Stroke as Rare Presentation of Pulmonary Embolism—Don't Jump the Gun

How to cite this article: Goyal A, Pallavi K, Awasthy AK. Persistent Hiccups in Posterior Circulation Stroke as Rare Presentation of Pulmonary Embolism—Don''t Jump the Gun. Indian J Crit Care Med 2022;26(9):1058–1059.