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Refractory central supratentorial hiccup partially relieved with vagus nerve stimulation
  1. Longatti Pierluigi1,
  2. Basaldella Luca1,
  3. Moro Mario1,
  4. Ciccarino Pietro1,
  5. Franzini Angelo2
  1. 1Divisione Clinicizzata di Neurochirurgia-Ospedale di Treviso, Università di Padova, Padua, Italy
  2. 2Neurochirurgia-Istituto Neurologico Nazionale C Besta, Milan, Italy
  1. Correspondence to Dr Luca Basaldella, Department of Neurosurgery, Treviso Regional Hospital, School of Medicine, University of Padua, Pzz.le Ospedale 1, 31100, Treviso, Italy; luca.basaldella{at}mac.com

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Case description

A 69-year-old male, with a 7-year history of persistent hiccups, came to our department after several unsuccessful traditional as well as alternative medical treatments. The symptoms began in January 1999, when the patient suffered a left insular ischaemic stroke with right hemiplegia and motor aphasia. Prompt medical management achieved full recovery of neurological functions; however, the hiccups emerged after a few days. The unwavering symptoms motivated the patient to visit our department 7 years later. The hiccups that began after the ischaemic stroke in 1999 were persistent: they lasted up to 20 successive days during awake states and sleep, each hiccup reappearing every 5–6 s. In addition, the hiccups were intense: within symptomatic periods, the hiccups progressively became disabling (9 on a 10-point scale according to the patient), and the patient lost 10 kg in weight. The hiccups often reached peaks with breath repercussions associated with glottic spasms and a choking sensation, resulting in profound anxiety and exhaustion. Within 7 years, the patient received several medical evaluations as well as aggressive medical treatment. Non-conventional therapies including acupuncture and shiatsu massages were also utilised. Furthermore, only transoesophageal stimulation resulted in temporary relief. In 2006, he was advised to undergo a neurosurgical examination. After imaging his brain and reviewing the …

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