Hiccups

Hiccups

A hiccup is an involuntary contraction (myoclonic jerk) of the diaphragm that may repeat several times per minute. It is known as synchronous diaphragmatic flutter (SDF), or singultus, Latin for the act of catching one’s breath while sobbing.

The hiccup is an involuntary action involving a reflex arc.

Once triggered, the reflex causes a strong contraction of the diaphragm followed about 0.25 seconds later by the closure of the vocal cords, which results in the classic “hic” sound.

Hiccups may occur individually, or they may occur in bouts. The rhythm of the hiccup, or the time between hiccups, tends to be relatively constant.

A bout of hiccups, in general, resolves itself without intervention, although many home remedies are often used to attempt to shorten the duration.

Hiccups caused by spinal cord tumor are rare.


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Lateral medullary syndrome

Medical treatment is occasionally necessary in cases of chronic hiccups.

May respond to chlorpromazine (Thorazine®) 25–50 mg PO TID-QID ✖ 2–3 days (if symptoms persist, give 25–50 mg IM)

Perampanel with baclofen may be effective for myoclonus due to respiratory reflex disinhibition and can be used to treat hiccups derived from cerebral infarctions 1).

A 52-year-old man developed a cerebral infarction from the right middle cerebral artery occlusion, and the infarction extensively damaged the right insula. Three months after the onset of the cerebral infarction, persistent hiccups appeared, occurring during sleep. The thoracic and abdominal cavities showed no lesions; hence, the hiccups were considered to be caused by the central nervous system dysfunction. Administration of metoclopramide, chlorpromazine, and diazepam were ineffective, while levetiracetam had a partial effect. Combining perampanel with baclofen finally suppressed the symptoms.

Lesions at the right insula impair control of ventilation and may present with hiccups as a symptom of respiratory reflex disinhibition. Morita et al. reviewed similar cases of treatment-resistant hiccups, as well as perampanel and baclofen efficacy in myoclonus cases.

This case suggested that perampanel with baclofen may be effective for myoclonus due to respiratory reflex disinhibition and can be used to treat hiccups derived from cerebral infarctions 2).


Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm 3).


Jeong et al. report a case of intractable hiccups caused by syringobulbia and syringomyelia associated with cervical intramedullary spinal hemangioblastoma, which was successfully treated by surgical excision. A 60-year-old man was referred from the neurology department after presenting with hiccups for 1 year. The hiccups were aggravated 3 months ago and were sustained during eating or sleeping. Several doctors administered a muscle relaxant and an anticonvulsant, but they were ineffective. Spinal MRI revealed a huge syringomyelia from C2 to T2, associated with a highly enhancing intramedullary mass lesion at the C5 level. The hiccups were ceased after removal of the tumor through a right hemilaminectomy. The pathology of the specimen was hemangioblastoma. The size of the syringobulbia and syringomyelia decreased markedly on MRI checked 5 months after surgery 4).


1) , 2)

Morita K, Nuki Y, Hashizume H, Togo M. Persistent Hiccups Induced by Supratentorial Infarcts and Successful Treatments With Combination of Perampanel and Baclofen: A Case Report. Clin Neuropharmacol. 2022 Aug 4. doi: 10.1097/WNF.0000000000000514. Epub ahead of print. PMID: 35947416.
3)

Hashiguchi M, Fujita A, Ikeda M, Morikawa M, Kohmura E. Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm. World Neurosurg. 2017 Dec 27. pii: S1878-8750(17)32234-9. doi: 10.1016/j.wneu.2017.12.118. [Epub ahead of print] PubMed PMID: 29288849.
4)

Jeong JH, Im SB, Shin DS, Hwang SC, Kim BT. Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma. Eur Spine J. 2015 Feb 26. [Epub ahead of print] PubMed PMID: 25716660.

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