Intractable Hiccups Research Articles

Hiccups, severe vomiting and longitudinally extensive transverse myelitis in a patient with prostatic adenocarcinoma and Aquaporin-4 antibodies

Neuromyelitis optica spectrum disorder (NMOSD) is not defined as a classical paraneoplastic neurological syndrome, however there are growing evidences that NMOSD may be rarely associated with cancer. Older (>45 years old) male patients with longitudinally extensive transverse myelitis (LETM) or patients with “area postrema” syndrome (intractable vomiting and hiccups) at onset are at higher risk for neoplasm-associated NMOSD. We report the case of 79-years old man who developed, a month after radiotherapy for prostatic adenocarcinoma, an area postrema syndrome rapidly followed by a LETM involving the whole spinal cord (from C2 to the conus). Aquaporin-4-IgG antibodies were positive in serum.

A case report of chronic dysphagia, intractable hiccups, vomiting, and sever gastroesophageal reflux as symptoms of a posterior cranial fossa hemangioblastoma

A case report of chronic dysphagia, intractable hiccups, vomiting, and sever gastroesophageal reflux as symptoms of a posterior cranial fossa hemangioblastoma

Treatment of Intractable Hiccup with Abdominal Acupuncture

Treatment of Intractable Hiccup with Abdominal Acupuncture

Conversion disorder presenting as intractable hiccups in middle-aged male

Hiccups are common and often don’t require treatment. Intractable hiccups, on the other hand, are often bothersome for the patient and require therapy. Formerly known as “psychogenic”, “functional” or “hysteria”- “conversion disorder” usually present with either or both sensory and motor function deficiencies. Common in females and having a varied presentation, conversion disorders are difficult to diagnose. When an uncommon presentation of them like intractable hiccups present in sex with a lesser predisposition, the diagnosis may be missed and not appropriately managed.

Vagal stimulation in a patient with intractable hiccups

A temporary hiccup is an occasional happening experienced by everyone. It occurs spontaneously and readily subsides with no lasting impact. However, rarely, hiccups can last for significant periods of time causing considerable debilitating illness in the patients.

Changes in the extracted amounts and seasonally variable constituents of Diospyros kaki at different growth stages.

Persimmon Calyx is a crude drug derived from the persistent calyx of mature fruit of Diospyros kaki Thunberg (Ebenaceae) and is used for the treatment of intractable hiccups. Although there are several reports on the isolation of constituents from Persimmon Calyx, its active constituents have not been elucidated. In this study, by focusing on the medicinal part of Persimmon Calyx, calyx on mature fruit of D. kaki, we examined the changes in the extraction amounts of 3 cultivars of D. kaki ('Hiratanenashi', 'Jiro', and 'Tonewase') to identify and quantify seasonally variable constituents during the maturation process by analysing their chemical compositions. We found that the extraction weight of the calyx, fruit of persimmons, and total tannin content in calyxes were significantly increased during maturation. Lupeol (1), betulinic acid (2), pomolic acid (3), ursolic acid (4), β-sitosterol (5), rotungenic acid (6), barbinervic acid (7), catechin (8), gallocatechin (9), and sucrose (10) were identified in the calyx of D. kaki. Compounds 1, 6, and 7 were isolated from Persimmon Calyx for the first time. Moreover, the isolated compounds (1-7) and their analogue (oleanolic acid) were quantitatively analysed, and the results showed that the amounts of 4 and oleanolic acid were reduced during maturation, whereas that of 2, 3, 6, and 7 were increased.

Area postrema syndrome as initial manifestation in neuromyelitis optica spectrum disorder patients: A retrospective study.

Area postrema syndrome (APS) is recognized as a core feature in neuromyelitis optica (NMO) diagnosis. Isolated APS can occur at NMO onset and frequently results in a delay of diagnosis, along with devastating secondary neurologic deficits. To date, few studies have characterized APS-onset neuromyelitis optica spectrum disorder (APSO-NMOSD). We aimed to describe the clinical and radiologic features of patients with APSO-NMOSD who are initially misdiagnosed in a cohort of patients from Zhengzhou, China. We identified 15 patients who presented with APS as an initial manifestation, based on the 2015 international consensus diagnostic criteria for NMOSD, and reviewed their demographic, clinical, laboratory, and magnetic resonance imaging (MRI) data. Fifteen patients (3 men, 12 women) aged 14-50years old were included in our study. All patients presented with APS that included intractable nausea, vomiting, or hiccups (INVH) as the initial manifestation; many experienced a delay in diagnosis. Serum AQP4 was positive in eleven patients and myelin oligodendrocyte glycoprotein (MOG) in one patient. All patients had a linear medullary lesion or a linear medulla-spinal lesion on sagittal MRI. An "inverted V sign" on axial medulla oblongata images, representing a lesion involving the area postrema, was noted in seven patients in this study. APS can occur as a sole and initial manifestation of NMOSD, often leading to misdiagnosis in the early process of disease. Identifying patients with an "inverted V" sign and a linear medullary lesion upon MRI examination can help to quickly identify APS patients and avoid further diagnostic delays.

S1588 The Value of Inspection: Physical Exam Reveals Pancreatic Malignancy

INTRODUCTION: Umbilical tumor (Sister Mary Joseph Nodule, SMJN) is a rare, but well described manifestation of malignancy. As of 1998, 407 cases had been published, of which only 37 (9%) were metastatic pancreatic adenocarcinoma. Clinical recognition is key as early therapy is necessary for optimal patient outcomes. Herein, we report such a case of pancreatic adenocarcinoma presenting with SMJN. CASE DESCRIPTION/METHODS: A 61-year-old African-American male presented for 2 weeks of decreased appetite with nausea and vomiting accompanied by aching abdominal pain after eating at a new restaurant. Following this hospitalization, he followed up with our clinic and was referred to urology and gastroenterology for cancer screening after he reported a 40 pound unintentional weight loss. As part of workup, computed tomography (CT) with contrast was obtained revealing 6.1 × 3.6 cm area of heterogeneity in tail of pancreas and a left subdiaphragmatic mass. He was referred to advanced endoscopy. Exam at that time was significant for umbilical drainage worrisome for enterocutaneous fistula. He underwent esophagogastroduodenoscopy with endoscopic ultrasound, revealing 5 × 5 cm ill-defined, hypoechoic and heterogenous mass with irregular borders in the tail of the pancreas. 22-gauge needle was used for 4 passes with slow pull technique to obtain fine needle biopsy. He was soon readmitted with intractable hiccups, and CT at that time revealed worsening metastases and a 3 × 3 cm umbilical mass felt to be consistent with SMJN. Pathology showed invasive moderately differentiated adenocarcinoma with mucinous and focal signet ring cell features. Case reviewed by hepatobiliary tumor board. In light of lack of other lesions visualized on endoscopy, it was felt this likely represented a particularly rare presentation of pancreatic adenocarcinoma. Patient has followed with oncology and has tolerated chemotherapy without incident thus far. After a full cycle of chemotherapy the initial finding of SMJN completely disappeared. DISCUSSION: This case represents a particularly rare presentation of pancreatic adenocarcinoma. It highlights the importance of careful physical examination and consideration of findings as such subtle signs may be the earliest indication of underlying malignancy. Early aggressive therapy is critical, hence early detection is crucial to optimizing patient outcomes. This case also highlights the need to consider pancreatic malignancy in considering an umbilical mass so as not to miss such an important diagnosis.Figure 1.: Sister Mary Joseph Nodule before treatment.Figure 2.: Resolution of Sister Mary Joseph Nodule after cycle 1 of chemotherapy.

A case of neuromyelitis optica spectrum disorder that relapsed with isolated intractable hiccup and nausea

A case of neuromyelitis optica spectrum disorder that relapsed with isolated intractable hiccup and nausea

Cranio-cervical junction dural arteriovenous fistula mimicking neuromyelitis optica spectrum disorders presenting with intractable hiccups: a case report

Cranio-cervical junction dural arteriovenous fistula mimicking neuromyelitis optica spectrum disorders presenting with intractable hiccups: a case report

Hiccups: A Non-Systematic Review.

Hiccups are a universal phenomenon. They are usually benign and selflimited. Persistent or intractable hiccups, although rare, can be debilitating and may indicate the presence of an underlying pathological process. To familiarize physicians with the pathophysiology, etiology, evaluation, and management of children with hiccups. A search was conducted on December 10, 2019, in Pubmed Clinical Queries using the key terms "hiccup" OR "hiccough" OR "singultus". The selected publication types included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including meta-analysis and narrative reviews) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Overdistension of the stomach is the most commonly identifiable cause of acute hiccups, followed by gastroesophageal reflux and gastritis. Other causes of hiccups, notably persistent and intractable hiccups, include an underlying gastrointestinal, neurological, cardiovascular, pulmonary, infectious, and psychogenic disorder. Persistent or intractable hiccups can be a harbinger of serious medical pathology. A detailed history and thorough physical examination may provide clues for the etiology of the hiccups. The treatment of hiccups should be directed at the underlying cause whenever possible. Bouts of acute hiccups less than 48 hours rarely require medical intervention as they usually resolve within minutes. Treatment may be considered when hiccups are bothersome, persistent, or intractable. Treatment modalities include lifestyle changes, physical maneuvers, pharmacotherapy and, very rarely, surgical intervention. Acute hiccups are usually benign and self-limiting. Persistent or intractable hiccups can be a harbinger of serious medical pathology. The underlying cause should be treated if possible. There are no formal guidelines for the treatment of hiccups. Currently, most of the methods proposed are based on case reports and anecdotal evidence. Terminating an episode of hiccups can be very challenging for a clinician but may tremendously improve the patient's quality of life. It is hoped that future well-designed and better-powered studies will provide us with more information on the efficacy of various treatment modalities for hiccups.

A case of area postrema syndrome associated with sick sinus syndrome in an elderly patient with neuromyelitis optica spectrum disorder: Case report

AbstractWe described an elderly man with neuromyelitis optica spectrum disorder (NMOSD) causing sick sinus syndrome (SSS) following intractable hiccups caused by area postrema syndrome (APS). He had multiple cardiovascular risk factors including coronary angina, diabetes mellitus, hyperlipidemia, and smoking history. His SSS resolved following the disappearance of the hiccups. Clinicians should be aware that severe bradyarrhythmia could be associated with APS, especially in NMOSD patients.

Gas instantly cures two-year intractable hiccups

Gas instantly cures two-year intractable hiccups

An Investigation of Hiccups

This previously healthy dextral 17-year-old boy presented with migrating paresthesia, pain at the posterior hairline, and intractable hiccups over four weeks. An evaluation for infections and inflammatory disorders was unremarkable, as was his head computed tomography. Physical examination was notable for a right pronator drift, weakness and numbness of right fifth digit flexion and arm flexion, and diminished sensation of the distal right lower extremity and fourth and fifth fingers. Full neuraxis magnetic resonance imaging (Fig) demonstrated a hemorrhagic cervicomedullary lesion extending from the medulla to C4-C5, 9.5 cm × 1.7 cm × 1.9 cm.

Baclofen Induced Encephalopathy in Patients with Chronic Kidney Disease

Hiccups are manifestation of uremic syndrome. Baclofen had been used in uremic hiccups, but its usage has been described in literature with development of neurotoxicity in patients with renal failure. The case series reports three patients of Chronic Kidney Disease (CKD) that were on haemodialysis. All of them had intractable hiccups, for which Baclofen was administered. They developed encephalopathy within 24-48 hours of ingestion of Baclofen. The drug was discontinued and the patients improved within 36-48 hours. They were finally discharged with no residual neurological deficit.

Acupuncture therapy for persistent and intractable hiccups: Protocol of a systematic review and meta-analysis.

Background:Persistent and intractable hiccups bring serious inconvenience to patients’ work and daily life, and impair their quality of life. Relevant studies showed that acupuncture therapy might be effective in treating persistent and intractable hiccups. However, there is no consistent conclusion so far. The aim of our research is to investigate the safeties and effectiveness of acupuncture in treating patients with persistent and intractable hiccups.Methods:We will search randomized controlled trials (RCTs) using acupuncture therapy to treat persistent and intractable hiccups in the following 6 English electronic databases and 3 Chinese electronic databases: MEDLINE, EMBASE, the Cochrane Library, Web of Science, PsycINFO, Allied and Alternative Medicine (AMED), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) and Wanfang data. The cure rate and the total effective rate will be considered as the primary outcomes. Complete cessation within a given period post-treatment of hiccups, changes in frequency or intensity of hiccups, concomitant symptom score, and adverse events will be considered as secondary outcomes. We will use Endnote software 9.1 for studies selection, Review Manager software 5.3, and STATA 13.0 software for analysis and synthesis.Results:we will synthesize current studies to evaluate the the safeties and effectiveness of acupuncture for persistent and intractable hiccups.Conclusion:Our study will provide evidence of acupuncture therapy for persistent and intractable hiccups.

Demyelinating syndrome in systemic sclerosis and neuromyelitis optica

BackgroundThis article reports a case diagnosis of a 44-year-old female who presented with intractable hiccups and vomit complicated with an acute onset of paraplegia. Transverse myelitis was evident on MRI and serological studies were consistent with Neuromyelitis Optica (NMO) based on NMO-IgG sero-positivity. Further studies revealed positive ANA, anti-RNA polymerase III autoantibodies, and Scl-70, leading to a concurrent diagnosis of systemic sclerosis (SSc). The coexistence of these two disease processes and their underlying clinical manifestations and therapeutic interventions are seldom reported in literature and are worth reporting.Case presentationThe patient was treated with high dose steroids, and subsequently developed malignant hypertension and acute renal failure, later identified on biopsy as steroids-induced scleroderma renal crisis. Although Neuromyelitis Optica spectrum disorder (NMOSD) has often been associated with various collagen and autoimmune diseases, the coexistence of NMOSD and SSc presented a challenge where the patient underwent aggressive physical therapy and necessitated an intervention with Rituximab to achieve an appropriate clinical response.We have received a written consent forms from the participant in our study, and we have them on file in case they are requested. We have also received the patient’s written consent for the data and images presented in this article.ConclusionThis article expands on NMOSD associated autoimmune diseases. Systemic Sclerosis is an insidious disease that is often diagnosed late as not all patients often report skin manifestation. The finding suggests that patients presenting with acute neurological manifestations get tested for NMO-IgG/AQP-4 antibodies and other immunological studies based on clinical findings.

The role of autonomic nervous system in intractable hiccup: A review

Hiccups are reflexes characterized by the onset of sudden diaphragmatic and intercostal muscle contraction immediately followed by laryngeal closure leading to the production of a “hic” sound. Hiccup is experienced a number of times through life, it’s usually self-limiting and resolves on its own. However, when it becomes intractable (lasting more than a month), it poses a serious chronic ailment that causes exhaustion, dehydration, weight loss, poor sleep and eating patterns. Intractable hiccup is a common complication of brain surgery but little is known about its pathophysiology and exact cause, although a number of factors has been implicated with the autonomic system playing a major role in one such involvement. A case of intractable hiccup in Dammam, Saudi Arabia was explored. In this study we reviewed the literature and found the role of the CNS and PNS in the onset of hiccups as well as known treatment methods for intractable hiccups and future prospects.

A RARE CASE OF SHINGLES WITH PERSISTENT SINGULTUS AND RESPIRATORY FAILURE

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Herpes zoster, also known as shingles, occurs after reactivation of latent varicella-zoster virus in sensory ganglia. There have been few cases reporting intractable singultus as a complication of shingles; however, none has reported a patient such as ours who presented with intractable hiccups along with hematemesis and acute hypoxic and hypercapneic respiratory failure. CASE PRESENTATION: A 53 year old Caucasian male with a history of Hypertension, GERD, and a recent episode of shingles presented to the ED with a 3 day history of worsening persistent singultus. Five days prior, he developed burning back pain followed by an eruption of a herpetiform rash along the T4-T5 dermatome on the right thorax. He was diagnosed with shingles and started on oral valacyclovir. Two days later, he developed progressively intense paroxysmal hiccup attacks with associated dyspnea and retching that was unresponsive to chlorpromazine. In the ED, he denied URI symptoms, recent travel, neurological deficits, trauma, or recent surgeries. On physical exam, he was afebrile and had a vesicular rash overlying the anteroposterior thorax along the T4-T5 dermatome. He had no electrolyte abnormalities. In the ER, he was started on intravenous acyclovir for herpes zoster; however, the hiccups were refractory to haloperidol, metoclopramide, and lorazepam. After several hours, he became encephalopathic, had hematemesis, and was subsequently intubated and placed on mechanical ventilation for acute hypoxic and hypercapneic respiratory failure. The hiccups terminated when he was sedated. Upon extubation the next day, the singultus resolved. The remainder of the hospital course was uneventful and he was discharged after a couple of days. DISCUSSION: Hiccups represent an involuntary spasmodic contraction of the diaphragm followed by rapid closure of the vocal cords involving the reflex arc and are rarely persistent. Potential causes of persistent singultus include infections, metabolic abnormalities, or structural disorders that irritate the branches of the vagus nerve, phrenic nerve, or the CNS. Treatment of hiccups is aimed at symptomatic relief and addressing the underlying cause. Physical maneuvers such as Valsalva can be initiated as empiric treatment. Pharmacological therapies include chlorpromazine, metoclopramide and muscle relaxants. Persistent hiccups due to Herpes Zoster have only been reported in exceptional few cases. In all previously reported cases, none had persistent hiccups associated with hypoxic and hypercapneic respiratory failure and hematemesis secondary to the retching effect of persistent singultus as a result of herpes zoster as which occurred in our patient. CONCLUSIONS: Physicians should closely monitor the respiratory status of patients who present with persistent singultus in the setting of shingles. Reference #1: Brooks WDW. Zoster, hiccup and varicella. Br Med J 1931;2:298-9 Reference #2: Efrati P. Obstinate hiccup as a prodromal symptom in thoracic herpes zoster. Neurology 1956;601-2 Reference #3: Berlin AL, Muhn CY, Billick RC. Hiccups eructation, and other uncommon prodromal manifestations of herpes zoster. J Am Acad Dermatol 2003;49:1121-4 DISCLOSURES: No relevant relationships by Abilio Arrascaeta Llanes, source=Web Response No relevant relationships by Nikita Cadet, source=Web Response No relevant relationships by Edison Gavilanes, source=Web Response No relevant relationships by Hao kee Ho, source=Web Response No relevant relationships by Princess Mark-Adjeli, source=Web Response No relevant relationships by Zubin Tharayil, source=Web Response

1714 A Case of a Primary Large Cell Neuroendocrine Carcinoma of the Esophagus Disguised as a Food Impaction

INTRODUCTION: Neuroendocrine carcinomas (NECs) are defined epithelial neoplasms with predominant neuroendocrine differentiation. They primarily arise from the gut and bronchopulmonary systems with the possibility of distant metastasis. We present a case of an esophageal neuroendocrine neoplasm with unique endoscopic/radiographic features on presentation disguised as a food impaction. CASE DESCRIPTION/METHODS: A 50-year-old Caucasian male with past medical history of tobacco dependence; presented to the ED with complaints of solid food dysphagia for 1.5 months with unintentional weight loss of 15 lbs and intractable hiccups. On arrival, he was hemodynamically stable. Physical exam was unremarkable. Laboratory testing revealed mild normocytic anemia of 12.3, otherwise unremarkable. An upper endoscopy was performed revealing a large amount of meat in the mid-esophagus; however, after further manipulation there appeared to be bleeding from the mucosa (Figure 1). Upon closer inspection, a mass originating from the lateral esophageal wall was caked with food debris giving it the appearance of meat. CT Chest was performed showing a large heterogenous esophageal mass (8.1 cm v 5.7 cm) extending from the mid-esophagus to the GE junction with no evidence of direct invasion (Figure 2). Biopsies returned positive for large cell neuro-endocrine carcinoma with diffuse synaptophysin and Ki67 positivity. PET-CT performed as outpatient showed prominent peri-gastric lymphadenopathy. EUS was attempted but failed due to inability to pass the ultrasound scope. CT surgery subsequently performed a McKeown transthoracic esophagectomy for definitive therapy as outpatient. He recovered well from the procedure with positive radial margins and lymph nodes on pathology and is now undergoing adjuvant radiation and chemotherapy. DISCUSSION: Esophageal NEC is a rare entity with a generally dismal prognosis when high-grade. A study out of a large volume, tertiary center reported approximately 40 cases over a 20-year period. Given the sparsity of esophageal NECs, most studies are retrospective case series and are from outside the USA. It is reported that esophageal NECs represent only 0.4-1.4% of the gastrointestinal NECs a majority of which arise from the mid-esophagus. To our knowledge, there is no reports of a single case with similar endoscopic and radiographic findings which makes it unique. There is also limited data reported on the endoscopic/phenotypic appearance of large cell neuroendocrine carcinomas of the esophagus.