• Na Zhang, Hao Liang, Xibing Wang, and Hong Wang.
• Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China.
• Medicine (Baltimore). 2023 Feb 17; 102 (7): e33053e33053.

RationaleDiagnosis of posterior circulation stoke is difficult, and magnetic resonance imaging especially diffusion-weighted imaging is superior to computed tomography. Persistent hiccups, sinus arrest, and post-hiccup syncope are extremely rare symptoms of posterior circulation stroke. However, there is no effective treatment for persistent hiccup.Patient Concern And DiagnosisWe describe a case of a 58-year-old hypertensive woman diagnosed with acute posterior circulation stroke who presented with persistent hiccups, sinus arrest, and post-hiccup syncope. Diffusion-weighted imaging revealed a high-intensity signal involving the left middle cerebellar peduncle and several spotted areas in the right occipital lobe.InterventionsPermanent pacemaker was implanted and metoclopramide was used to treat persistent hiccups.OutcomeThe patient developed aspiration pneumonia and morbid dysphoria, and eventually died.LessonsPosterior circulation stroke can cause cardiovascular and respiratory dysfunction. Consequently, physicians should pay more attention to posterior circulation lesions in patients with arrhythmia and syncope. An effective method to treat persistent hiccups is urgently needed.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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