Prolonged hiccups induced by renal infarction: a case report.

BACKGROUND: Hiccups are common symptoms that last for less than 48 hours. However, we encountered a case of renal infarction in a patient with prolonged hiccup. The relationship between hiccups and renal infarction is important in differentiating patients with prolonged hiccups. CASE PRESENTATION: An 87-year-old Japanese man with atrial fibrillation and receiving antithrombotic therapy presented to the emergency department with prolonged hiccups. The patient discontinued antithrombotic therapy for atrial fibrillation due to subcortical bleeding, after which he experienced right back pain. He was diagnosed with right renal infarction based on computed tomography images, and the antithrombotic therapy was continued. The patient's hiccups ceased, and he was discharged on hospital day 11. CONCLUSION: Hiccups can be induced by various clinical conditions. It is hypothesized that the inflammation of the right kidney infarction stimulated the diaphragm and induced prolonged hiccups in this patient; this theory is supported by the computed tomography images. This case report shows that internal organ diseases irritating the diaphragm can cause hiccups, and renal disease should be considered in patients with prolonged hiccups.

Vedvarende hikke etter perforert kolecystitt.

BACKGROUND: Persistent hiccups lasting more than 48 hours are rare and have numerous possible causes that require further investigation. CASE PRESENTATION: We present a man in his seventies who was admitted to hospital after 11 days of hiccups. The hiccups were preceded by abdominal pain that spontaneously receded after a few hours. At admission he had no abdominal pain during examination, but a CT scan later suggested that the cause was a perforated cholecystitis with an intra-abdominal abscess. The abscess was drained percutaneously and treated with antibiotics, and the hiccups stopped. INTERPRETATION: Persistent hiccups warrant thorough examination, and it is recommended to consider CT scans of the head and truncus, cerebral MRI scan and an upper GI endoscopy. Treating the underlying cause of hiccups is the ultimate target, while symptomatic treatment simultaneously is preferred.

Phrenic nerve block combined with stellate ganglion block for postoperative intractable hiccups: a case report.

Postoperative intractable hiccups slow patient recovery and generate multiple adverse effects, highlighting the importance of investigating the pathogenesis and terminating the hiccups in a timely manner. At present, medical and physical therapies account for the main treatments. We encountered a case in which postoperative intractable hiccups after biliary T-tube drainage removal ceased with the application of an ultrasound-guided block of the unilateral phrenic nerve and stellate ganglion. No complications developed, and the therapeutic effect was remarkable. To our knowledge, this approach has not been reported to date. Simultaneously blocking the phrenic nerve and stellate ganglion may be a treatment option for intractable hiccups.

Acupuncture in the treatment of post-stroke hiccup: A systematic Review and meta-analysis.

Aim: Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments exhibit limited efficacy and pronounced side effects. Acupuncture has been explored as a supplementary intervention in clinical practice. This study aims to investigate the clinical effectiveness of acupuncture for post-stroke hiccups.Methods: To identify published clinical randomized controlled trials addressing post-stroke hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager 5.4 software, three authors independently reviewed literature, extracted data, and evaluated study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4.Results: A total of 18 trials were encompassed in the analysis. In comparison to standard treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR: 1.27, 95% CI: 1.21-1.33; P < 0.00001). Notably, Hiccup Symptom Score displayed a considerable decrease (WMD: -1.28, 95% CI: -1.64 to -0.93; P < 0.00001), concurrent with a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323-9.617; P < 0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16-1.25; P = 0.13), and there was a significant reduction in SAS (WMD: -7.23, 95% CI: -8.47 - -5.99; P < 0.00001).Conclusions: Our investigation suggests that acupuncture could prove effective in post-stroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the included studies, conducting higher-quality randomized controlled trials to validate their efficacy is imperative.

Intractable hiccups after VNS implantation: a case report.

BACKGROUND: Hiccups (medically termed, "singultus"), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy. CASE PRESENTATION: We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient's hiccups persisted and only stopped once the VNS was permanently deactivated. CONCLUSIONS: Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.

[Analysis of the clinical characteristics and misdiagnosis of area postrema syndrome manifesting as intractable nausea, vomiting, and hiccups in neuromyelitis optica spectrum disorders].

Objective: To investigate the misdiagnosis of area postrema syndrome (APS) manifesting as intractable nausea, vomiting and hiccups in neuromyelitis optic spectrum disease (NMOSD) and reduce the risk of misdiagnosis. Methods: We retrospectively analyzed data from NMOSD patients attending the Department of Neurology at the First Medical Center of PLA General Hospital between January 2019 and July 2021. SPSS25.0 was then used to analyze the manifestations, misdiagnosis, and mistreatment of APS. Results: A total of 207 patients with NMOSD were included, including 21 males and 186 females. The mean age of onset was 39±15 years (range: 5-72 years). The proportion of patients who were positive for serum aquaporin 4 antibody was 82.6% (171/207). In total, 35.7% (74/207) of the NMOSD patients experienced APS during the disease course; of these patients, 70.3% (52/74) had APS as the first symptom and 29.7% (22/74) had APS as a secondary symptom. The misdiagnosis rates for these conditions were 90.4% (47/52) and 50.0% (11/22), respectively. As the first symptom, 19.2% (10/52) of patients during APS presented only with intractable nausea, vomiting and hiccups; 80.8% (42/52) of patients experienced other neurological symptoms. The Departments of Gastroenterology and General Medicine were the departments that most frequently made the first diagnosis of APS, accounting for 54.1% and 17.6% of patients, respectively. The most common misdiagnoses related to diseases of the digestive system and the median duration of misdiagnosis was 37 days. Conclusions: APS is a common symptom of NMOSD and is associated with a high rate of misdiagnosis. Other concomitant symptoms often occur with APS. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing physical examinations are essential if we are to reduce and avoid misdiagnosis.

Case report and literature review: A hiccup patient developed encephalitis and duodenal perforation.

Brainstem encephalitis is rare and this study aims to report the clinical course, imaging features, and therapeutic response of hiccup patient with gastric ulcer who developed brainstem encephalitis with Epstein-Barr virus (EBV) detected in cerebrospinal fluid and then subsequently followed by development of duodenal perforation. Data of a gastric ulcer patient who suffered from hiccups, with brainstem encephalitis detected and then subsequently suffered from duodenal perforation were collected retrospectively and analyzed. A literature search was conducted on Epstein-Barr virus associated encephalitis using keywords like "Epstein-Barr virus encephalitis" and "brainstem encephalitis," "hiccup." The etiology of EBV-related brainstem encephalitis in this case report is not clear. However, from the initial hiccup to the presentation of both brainstem encephalitis and duodenal perforation during the course of hospitalizations builds up an uncommon case.

Healthcare Providers' Experiences with Hiccups in Patients with Cancer: Report of a United States National Survey.

Hiccups occur in 15-40% of cancer patients, but previous research has not sought the perspectives of cancer healthcare providers. The objective of this research is to report on United States cancer healthcare providers' awareness of their patients' hiccups and these healthcare providers' perceived need for further palliation options. A survey was developed and then distributed throughout the United States via email to cancer healthcare providers; results are reported descriptively. Six hundred eighty-four cancer healthcare providers completed 2 eligibility screening questions which required them to have cared for an adequate number of patients (> 10 in the past 6 months) with "clinically significant" hiccups (defined as hiccups that persisted for >48 hours or occurred from cancer or from cancer care). Of 113 eligible healthcare providers, 90 completed the survey. Healthcare providers described hiccups as associated with stress/anxiety, fatigue, sleep problems, and decreased work/school productivity. In 49% of patients, healthcare providers initially prescribed medications (commonly chlorpromazine or baclofen); 18% expressed dissatisfaction with current palliation. Proffered comments included, "When current therapies do not work, it can be very demoralizing to our patients; " and "…my biggest complaint is that current treatments also come with their own side effects which can be quite severe." Discordance appears to exist between the percentage of cancer patients with hiccups and the percentage of cancer healthcare providers with awareness of their patients' hiccups. Nonetheless, healthcare providers described notable hiccup-associated symptoms in their patients and a need for more palliative options.

Cervical repetitive peripheral magnetic stimulation relieves idiopathic persistent hiccups: A preliminary study of case report.

OBJECTIVE: We postulated that repetitive peripheral magnetic stimulation (rPMS) might treat idiopathic persistent hiccups. This study aimed to determine the clinical effect of rPMS on hiccup alleviation. METHODS: Seven patients with idiopathic persistent hiccups experienced the cervical rPMS session (1 Hz, 656 stimuli) in this prospective clinical series from November 2018 to May 2021. The rPMS session was applied once daily until the hiccups were utterly relieved. During the treatment, the round coil was transversally positioned over the upper nape area, and the center of the coil was placed at the level of the C4 vertebrae. The subjective assessment scale (SAS) scores and the hiccup frequency were assessed before and after rPMS treatment. RESULTS: A total of 7 patients were enrolled. All were male post-stroke patients ([mean ±â€…SD] age, 58.5 ±â€…9.85 years) with dysphasia, 3 patients (3/7) were fed with a nasogastric tube, and 4 patients (4/7) were with dysarthria. The mean duration of hiccups was 4.14 ±â€…3.63 days (range 2-12 days). The rPMS therapy eliminated hiccups in all 7 patients. The mean sessions which stopped hiccupping were 3.43 ±â€…2.57 (range 1-9). The mean value of the SAS scores before rPMS therapy was 7 ±â€…1 (range 6-8), and it was decreased to zero after the therapy (0). No recurrence of hiccups was observed within 2 weeks of the last rPMS session. rPMS therapies were not associated with severe adverse effects. CONCLUSION: The cervical rPMS therapy is beneficial in treating idiopathic persistent hiccups, particularly in post-stroke patients.

A Medication Hiccup: Chlorpromazine-Induced Agranulocytosis in a 72-Year-Old Male.

INTRODUCTION: Agranulocytosis, a severe decrease or absence of neutrophils, is a side effect of several medications, including chlorpromazine. If not promptly recognized, it can lead to overwhelming infection, sepsis, and death. CASE PRESENTATION: A 72-year-old man with adenocarcinoma of the lung status-post recent lobectomy was admitted for postsurgical pain and electrolyte derangement. During his admission, he had intractable hiccups and was started on chlorpromazine 25 mg by mouth 3 times a day. Within a week, he developed pneumonia, type 1 respiratory failure, and a progressive neutropenia. Chlorpromazine-induced agranulocytosis was suspected and chlorpromazine was discontinued; however, the patient expired, with postmortem findings of aspergillus bronchopneumonia as cause of death. DISCUSSION: Chlorpromazine is a well-studied cause of agranulocytosis. This case is novel in its rapid time course of less than 1 week; most cases report the resultant agranulocytosis on the order of weeks rather than days. CONCLUSION: This case highlights an important need to recognize this medication side effect early so the offending agent may be stopped and the patient properly supported, so as to avoid the severe risk of neutropenic infection, sepsis, and death.

Area Postrema Syndrome in Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Case Series and Literature Review.

BACKGROUND AND OBJECTIVES: To report the frequency of area postrema syndrome (APS) in glial fibrillary acidic protein-immunoglobulin G (GFAP-IgG)-positive patients and emphasize the importance of APS among the phenotypes in autoimmune GFAP astrocytopathy. METHODS: Eight GFAP-IgG-positive cases with APS were retrospectively identified during 2015-2021. The APS phenotypes were described. A literature review of 8 previously reported cases was also included in analysis. RESULTS: A total of 8 patients (11%) (1 woman, 7 men; mean age: 52.4 ± 18.4 years) presented with APS in a cohort of 74 GFAP-IgG-positive patients, 3 of whom (4%) had disease onset with APS. All patients had hiccups, and hiccups was the unique symptom of APS in 5 patients. The median time from disease onset to APS occurrence was 2 days (range 0-20), and the mean duration of APS episodes was 23.6 ± 11.4 days. No patient had isolated APS attack. All episodes were completely resolved with a mean duration of 9.3 ± 5.4 days after immunotherapy. APS manifestations of 8 cases in previous studies showed similar features with our cases. In total, coexisting aquaporin-4-IgG was only detected in one of the 16 cases. DISCUSSION: APS could be an early, but not isolated clinical manifestation of autoimmune GFAP astrocytopathy. Hiccups was the predominant symptom of APS in this disorder. APS attacks of autoimmune GFAP astrocytopathy have good response to immunotherapy.