A diagnostic challenge in a young woman with intractable hiccups and vomiting: a case of neuromyelitis optica

Abstract

Intractable nausea and vomiting along with hiccups is a commonly encountered problem on any general medicine or gastroenterology service. These symptoms are usually not appreciated as the possible initial manifestation of neuromyelitis optica (NMO). Missing diagnosis at this early stage will lead to a delay in the treatment, and hence, irreversible complications including blindness and paraplegia could occur. We report a case of a 22-year-old young female who presented with intractable hiccups and vomiting. After extensive evaluation, she was found to have NMO which involved the area postrema, the vomiting center of the brain. Early diagnosis from the clinical picture aided by aquaporin-4 serologic testing is extremely important to allow early initiation of immunosuppressive therapy. Immunosuppression gives an opportunity to modify the disease at an earlier stage rather than waiting for evolution of disease to fulfill the diagnostic criteria of NMO.

Persistent hiccups as main COVID-19 manifestation with transient cytotoxic lesion of the corpus callosum splenium during the Omicron wave in the post-vaccination era

“…In conclusion, based on our case-report, we suggest that both CLOCCs and hiccups may be distinctive entities and not patho-physiologically linked to pneumonia, as previously hypothesized [6,13]. On the other hand, CLOCCs and hiccups may be pathogenically correlated rather than being incidental findings as already reported in a patient with neuromyelitis optica [14]. It is plausible that both COVID-19 infection and neuromyelitis optica may be characterized by an acute inflammatory damage, driven by COVID-19 axonal propagation and by an autoimmune process, respectively, synergically affecting both a large bundle of myelinated nerve fibers such as the splenium of the corpus callosum and leading to acute mononeuritis of the phrenic nerve and, consequentially, to a persistent hiccups [15].…”

Rapid assessment of health literacy on admission to the hospital

“…Also in this issue, we are publishing 18 additional manuscripts – the most in any issue to date. Case reports include three acute neurological presentations: neuromyelitis optica presenting as hiccups ( 10 ), intrapulmonary AVM presenting as cerebral emboli ( 11 ), and spontaneous internal carotid dissection presenting as amaurosis fugax ( 12 ). There are three cardiology cases: complete heart block caused by blunt trauma ( 13 ), cardiac lipoma ( 14 ), and a massive atrial mass ( 15 ).…”

Hiccups in neurocritical care

“…The dorsal area of the medulla is commonly associated with hiccups as it incorporates a number of complex structures which conciliate the reflex arc, including the vagus nerve, respiratory center, solitary nucleus, nucleus ambiguus, central sympathetic tract, and spinal tract of trigeminal nucleus. Chronic hiccups have been reported following hemorrhagic and ischemic strokes, cerebellar aneurysms, and neuromyelitis optica [32][33][34][35][36][37][38].…”