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Intractable hiccup induced by cavernous angioma in the medulla oblongata: case report
  1. Marcelo Mattana,
  2. Paulo Ricardo Mattana,
  3. Marcelo R Roxo
  1. Department of Neurosurgery, Hospital Saúde, Caxias do Sul–RS, Brazil
  1. Correspondence to Dr Marcelo Mattana, Rua Garibaldi 476, sala 602, Caxias do Sul—RS, Brazil; marmattana{at}

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Hiccups are defined as an abrupt involuntary contraction of the diaphragm and intercostal muscles with sudden closure of the glottis 35 ms after onset. It can be considered intractable when it persists for at least 24 h. There is no reliable estimated incidence of this problem, but it is known to be a rare manifestation of some diseases, the majority being due to extracranial causes (ie, intra-abdominal or intrathoracic causes).1


A 40-year-old man complained of three episodes of persistent, intractable hiccup associated with occipital intermittent headaches. The longest episode of hiccup occurred for 5 days. The man had no previous neurological history of disease, and he did not have any other complaints. He was treated with chlorpromazine and clonazepam, which had no effect on the hiccups. The physical and neurological examinations were completely normal. An MRI of the brain was performed and demonstrated a well-circumscribed, dorsal exophytic lesion at the level of the fourth ventricle in the medulla oblongata (figure 1A). A cavernous angioma was then suspected, 3 months after the first episode of …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.