Intractable hiccups as a sole manifestation of medullary cavernous hemangioma

Abstract

Intractable hiccups lasting over 48 hours can indicate serious medical conditions, including neurological disorders. Typically, such disorders present with other neurological symptoms, but hiccups may, in some cases, occur as the sole manifestation, delaying the underlying diagnosis. We report the case of a 37-year-old previously healthy man who experienced intractable hiccups for more than 50 days. Initial investigations, including chest and abdominal imaging and endoscopy, were unremarkable except for gastroesophageal reflux disease (GERD), which did not improve with standard treatment. A neurological examination revealed no abnormalities, but brain MRI showed a small cavernous hemangioma with subacute hemorrhage near the solitary nucleus in the medulla, which was thought to be responsible for the intractable hiccups. This case highlights the importance of considering small medullary lesions in the differential diagnosis of persistent hiccups, even in the absence of other neurological symptoms, and underscores the role of the solitary nucleus in the pathophysiology of intractable hiccups.