• Keisuke Sasaki, Tomoo Inoue, Takashi Inoue, Yasuo Nishijima, Toshiki Endo, Masayuki Ezura, Hiroshi Uenohara, Kuniyasu Niizuma, and Teiji Tominaga.
• Department of Neurosurgery, National Health Organization, Sendai Medical Center, Sendai, Miyagi, Japan; Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.
• World Neurosurg. 2020 Sep 1; 141: 64-68.

BackgroundHiccups are a well-known short-term phenomenon in daily life. If they persist or become intractable, they may be a primary symptom of a disease. Recent studies identified the medulla oblongata as the neuroanatomic center of the hiccup reflex arc. In previous cases, an isolated lesion at the dorsal side of the medulla oblongata induced intractable hiccups.Case DescriptionWe herein describe a patient with a perimedullary arteriovenous fistula (PMAVF) at the craniocervical junction who had intractable hiccups. A 70-year-old male presented with a 3-year history of intractable hiccups that continued for a few days every week. An initial examination failed to identify the underlying cause, and neither medicine nor self-treatment attenuated his symptoms. Intracranial T2-weighted magnetic resonance imaging showed a hyperintensity area within the dorsolateral medulla and flow voids along the dorsal side of the cervical spine. Angiography revealed PMAVF fed by the left C1 radiculomedullary artery. Obliteration of the fistula was performed, after which intractable hiccups had completely disappeared within 1 week.ConclusionsThis is the first case report of PMAVF at the craniocervical junction presenting with intractable hiccups that suggested a lesion in the dorsal side of the medulla. The mechanisms underlying hiccups are also discussed.Copyright © 2020 Elsevier Inc. All rights reserved.

24 keywords...

hide…