Abstract：
BACKGROUND:Hiccups are a well-known short-term phenomenon in daily life. If they persist or become intractable, they may be a primary symptom of a disease. Recent studies identified the medulla oblongata as the neuroanatomic center of the hiccup reflex arc. In previous cases, an isolated lesion at the dorsal side of the medulla oblongata induced intractable hiccups. CASE DESCRIPTION:We herein describe a patient with a perimedullary arteriovenous fistula (PMAVF) at the craniocervical junction who had intractable hiccups. A 70-year-old male presented with a 3-year history of intractable hiccups that continued for a few days every week. An initial examination failed to identify the underlying cause, and neither medicine nor self-treatment attenuated his symptoms. Intracranial T2-weighted magnetic resonance imaging showed a hyperintensity area within the dorsolateral medulla and flow voids along the dorsal side of the cervical spine. Angiography revealed PMAVF fed by the left C1 radiculomedullary artery. Obliteration of the fistula was performed, after which intractable hiccups had completely disappeared within 1 week. CONCLUSIONS:This is the first case report of PMAVF at the craniocervical junction presenting with intractable hiccups that suggested a lesion in the dorsal side of the medulla. The mechanisms underlying hiccups are also discussed.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Sasaki K,Inoue T,Inoue T,Nishijima Y,Endo T,Ezura M,Uenohara H,Niizuma K,Tominaga Tdoi
10.1016/j.wneu.2020.06.013subject
Has Abstractpub_date
2020-09-01 00:00:00pages
64-68eissn
1878-8750issn
1878-8769pii
S1878-8750(20)31271-7journal_volume
141pub_type
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