We present a case of persistent
hiccups (singultus) after a lateral medullary
cerebrovascular accident. The patient presented with a two-day history of
nausea and
vomiting. Clinically, the patient had a loss of
pain and temperature on the left side of the face, a loss of
pain and temperature on the right side of the trunk, a mild left
hemiparesis, and a left-sided
ataxia. Nystagmus,
diplopia, and
hiccups were also evident. A left
lateral medullary syndrome in the vascular distribution of the posterior inferior cerebellar artery was diagnosed. Work-up included a magnetic resonance imaging angiogram, which revealed an occlusion v high-grade
stenosis of the basilar artery. The patient reported that the most distressing symptom was the chronic
hiccups (25/min), which interfered with nutrition, sleep, and activity. While in the acute care hospital, the patient was treated with
prochlorperazine,
promethazine, and
chlorpromazine. Each of these medications was unsuccessful in stopping the
hiccups. After a search of the European literature revealed that
baclofen was recommended as the
drug of choice for stopping persistent
hiccups, the patient was given 5 mg of
baclofen by mouth three times per day, and the
hiccups abated within 48 hours. The
baclofen was discontinued after one week of
therapy, and the
hiccups did not return. We recommend consideration of
baclofen for the treatment of persistent
hiccups after
lateral medullary syndrome because of its desirable side effects and reported success rate compared with other drugs used to treat chronic
hiccups.