A case of vertebral artery dissection presented with refractory hiccups
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LETTER TO THE EDITOR
A case of vertebral artery dissection presented with refractory hiccups Hatice Ferhan Kömürcü1 · Halil Arslan2 · Ömer Anlar3 Received: 19 May 2020 / Accepted: 10 June 2020 © Belgian Neurological Society 2020
Dear Editor, Hiccup “singultus” is a respiratory reflex that occurs with sudden and involuntary contraction of the diaphragm and intercostal muscles. It is a benign symptom usually accompanied by gastrointestinal diseases. Neurological diseases can also cause hiccups, more frequently in those involving the brain stem. If hiccup lasts longer than 48 h, then it is defined as refractory “persistent” hiccup which is rarely seen. Organic etiology should be sought in prolonged hiccups. Herein, a case with a refractory hiccup and diagnosed as vertebral artery dissection is presented. It was learnt that a 43-year-old male patient who was referred to the neurology outpatient clinic had applied to the emergency service with a complaint of hiccup lasting for 2 days, and a reason that could explain hiccups could not be identified during the examinations and tests performed in the emergency department. The patient stated that 2 days ago he had complaints as feeling sick, and fainting, and felt as if he had seen glimmering lights, and exposed to electric shock and lightning strikes, and he had inclined to his right side while walking, and then hiccups started.
This case was previously presented as e-poster at the 53rd National Neurology Congress. * Hatice Ferhan Kömürcü [email protected] Halil Arslan [email protected] Ömer Anlar [email protected] 1
Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Hastane Sokak No:1/8 İçerenköy, Ataşehir, 34752 Istanbul, Turkey
2
Department of Radiology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
3
Department of Neurology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
His neurological examination was normal except for frequent hiccup attacks. Any obvious abnormal finding was not detected in the patient’s bilateral carotid and vertebral artery doppler ultrasonography. Cranial magnetic resonance imaging (MRI) was normal. In the computed tomography (CT) angiography, V3 segment of right vertebral artery was thinner according to the left side and there was thickening in the lateral wall compatible with dissection (Fig. 1). The time of flight (TOF) MRI angiography showed that there was a short segment dissection at the intracranial entry zone of V3 segment of the right vertebral artery in T1 and T2 vessel wall imaging (Fig. 2). Its appearance on CT was considered suspicious in favour of dissection. On cerebrocervical “digital subtraction angiography” (DSA) examination, a sign of dissection was found on V3–V4 segments of the right vertebral artery. Enoxaparin sodium, metoclopramide and chlorpromazine treatments were started for the patient. The patient’s hiccups ended within 2 days. Gastrointestinal diseases, especially gastroesophageal reflux and hiatal hernias are the mos
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