Giant PICA aneurysm presenting as intractable hiccups

Gambhir, Shanu; Singh, Amardeep; Maindiratta, Bhavna; Jaeger, M.; Darwish, Basma; Sheridan, Mark

doi:10.1016/j.jocn.2009.09.046

Cited by 20 publications

(18 citation statements)

References 14 publications

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“…Their presentation is similar to posterior fossa neoplasms inducing chronic brainstem or cerebellar compression [14]. Deficits such as truncal ataxia, hemiparesis, and intractable hiccups have been reported [2, 15]. …”

Section: Discussionmentioning

confidence: 99%

Thrombosed Large Distal Posterior Inferior Cerebellar Artery Aneurysm Mimicking an Infratentorial Ependymoma

Woo

Chan

2014

Case Reports in Neurological Medicine

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Large or giant intracranial aneurysms can simulate brain tumors clinically and radiologically by virtue of their progressive mass effect. Unlike aneurysms from alternative locations, those arising from the distal posterior inferior cerebellar artery (PICA) are uncommon. We report a patient who experienced progressive hemiparesis with magnetic resonance imaging findings suggestive of an infratentorial ependymoma. Intraoperatively, a thrombosed large aneurysm of the distal PICA was unexpectedly encountered. The aneurysm was clipped and the patient did not develop any permanent neurological deficit. This case illustrates the radiological nuances of large aneurysms and infratentorial ependymomas. Three-dimensional contrast-enhanced magnetic resonance angiography can be falsely negative and the importance of the “target” sign is emphasized. One should be cognizant of this possible diagnosis for patients with midline fourth ventricular lesions in order to reduce surgical risk.

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Section: Discussionmentioning

confidence: 99%

Thrombosed Large Distal Posterior Inferior Cerebellar Artery Aneurysm Mimicking an Infratentorial Ependymoma

Woo

Chan

2014

Case Reports in Neurological Medicine

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“…Intractable nausea, vomiting, and hiccups (IHN) is defined as symptoms lasting more than 48 h.[3] Neurological illnesses reported to present with intractable vomiting and hiccups are lateral medullary stroke, bilateral carotid artery dissection, giant posterior inferior cerebellar artery aneurysm, basilar artery aneurysm, posterior fossa arteriovenous malformation, cerebellar hemangioblastoma, syringobulbia, compressive lesions of medulla oblongata including cavernoma, ependymoma, choroid plexus papilloma, and tuberculoma. [45]…”

Section: Discussionmentioning

confidence: 99%

Intractable vomiting and hiccups as the presenting symptom of neuromyelitis optica

Kulkarni

Kallollimath

Ramakrishnan

et al. 2014

Ann Indian Acad Neurol

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Vomiting and hiccups can be due to peripheral or central causes. Neurological diseases causing vomiting and hiccups are due to lesions of medulla involving area postrema and nucleus tractus solitarius. Neuromyelitis optica (NMO) is one such disease which involves these structures. However refractory vomiting and hiccups as the presenting symptom of NMO is unusual. Here we report a patient with NMO in whom refractory vomiting and hiccups were the sole manifestation of the first attack. Diagnosis can be missed at this stage leading to delay in treatment and further complications. This case demonstrates the importance of considering NMO in any patient presenting with refractory vomiting and hiccups and with local and metabolic causes ruled out and linear medullary lesion on magnetic resonance imaging may indicate the diagnosis even when the classical clinical criteria are not met. Anti NMO antibody testing should be done and if positive appropriate treatment should be initiated to prevent further neurological damage.

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“…Therefore, these hiccups usually resolved after surgical resection of the brain lesions 17. Cerebellar artery aneurysm also reported to result in hiccup and that was effectively treated after surgery 20. Brain injury may cause intractable hiccup 21.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.

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Giant PICA aneurysm presenting as intractable hiccups

Cited by 20 publications

References 14 publications

Thrombosed Large Distal Posterior Inferior Cerebellar Artery Aneurysm Mimicking an Infratentorial Ependymoma

Thrombosed Large Distal Posterior Inferior Cerebellar Artery Aneurysm Mimicking an Infratentorial Ependymoma

Intractable vomiting and hiccups as the presenting symptom of neuromyelitis optica

Hiccup: Mystery, Nature and Treatment

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