Cases reported "Hiccup"

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1/12. Intractable hiccup: an odd complication after laparoscopic fundoplication for gastroesophageal reflux disease.

    Intractable hiccup can be an unbearable circumstance and its treatment is often frustrating. More than 100 causes for hiccup have been described in the literature; the most common cause is gastroesophageal reflux disease (GERD). We report a case of a 31-year-old patient who suffered from intractable hiccup starting 3 weeks after laparoscopic Nissen fundoplication for GERD, a potential surgical complication that has not been described. After frustrating medical treatment, the patient underwent computed tomography and nerve stimulator-guided blockade of vagal and phrenic nerves on each side separately. hiccup ceased only after blockade of the right phrenic nerve with 4 ml/h l% ropivacaine and relapsed soon after discontinuation. He underwent thoracoscopic right phrenicectomy, which rendered him symptom free for well over 2 months, at the time of this writing.
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2/12. Hiccups attributable to syringobulbia and/or syringomyelia associated with a Chiari I malformation: case report.

    OBJECTIVE AND IMPORTANCE: Approximately 20 to 50% of patients with syringomyelia associated with Chiari malformations exhibit cranial nerve or cerebellar symptoms. However, hiccups represent a rare clinical manifestation of this disorder. We report a case of intractable hiccups resulting from syringobulbia associated with a Chiari I malformation, which was successfully treated with foramen magnum decompression. CLINICAL PRESENTATION: We report the case of a patient who presented with syringomyelia and syringobulbia associated with a Chiari I malformation, manifested as intractable hiccups and neurological deficits. magnetic resonance imaging scans demonstrated syringobulbia in the dorsal medullary region and a large cervical syrinx from C2 to C6-C7, associated with a Chiari I malformation. INTERVENTION: foramen magnum decompression and a C1 laminectomy were performed. One month later, the intractable hiccups disappeared and the neurological symptoms demonstrated improvement. CONCLUSION: Postoperative magnetic resonance imaging scans demonstrated enlargement of the subarachnoid space in the posterior fossa and disappearance of the syringobulbia. There has been no recurrence of intractable hiccups and syringobulbia in 6 months after surgery. magnetic resonance imaging of the brainstem is an important diagnostic procedure for intractable hiccups, because syringobulbia associated with a Chiari malformation represents a surgically treatable disorder, although the incidence is low.
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3/12. vagus nerve stimulation for chronic intractable hiccups. Case report.

    Intractable hiccups are debilitating and usually a result of some underlying disease. Initial management includes vagal maneuvers and pharmacotherapy. When hiccups persist despite medical therapy, surgical intervention rarely is pursued. Cases described in the literature cite successful phrenic nerve blockade, crush injury, or percutaneous phrenic nerve pacing. The authors report on a case of intractable hiccups occurring after a posterior fossa stroke, Complete resolution of the spasms has been achieved to date following the placement of a vagus nerve stimulator.
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4/12. Intractable hiccup as the initial presenting feature of systemic lupus erythematosus.

    An infarctus of medulla oblongata was discovered in a 44-year old man with an intractable hiccup and 10, 11th and 12th right cranial nerves palsies. Systemic lupus erythematosus (SLE) with antiphospholipid syndrome was subsequently diagnosed. hiccup has withdrew with corticosteroid therapy and low-dose aspirin. The other cases of literature and pathophysiologic hypotheses are briefly reported.
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keywords = nerve
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5/12. Persistent hiccups after attempted interscalene brachial plexus block.

    OBJECTIVE: We describe a case of persistent hiccups after attempted interscalene brachial plexus block. CASE REPORT: A 38-year-old man was admitted for arthroscopic repair of a right shoulder injury. An interscalene block was attempted in the preoperative area and combined with general anesthesia for surgery. The procedure lasted 5(1/4) hours. After transfer to the recovery room, the patient complained of severe right shoulder pain and had no discernible sensory or motor block. He was noted to be hiccuping. The patient was discharged home the following morning but returned 2 days later complaining of persistent hiccups since surgery, with associated insomnia and nausea. He was readmitted and given chlorpromazine 50 mg intravenously every 8 hours and metoclopramide 10 mg intravenously every 6 hours. The patient was discharged 4 days later on chlorpromazine 25 mg by mouth every 8 hours and baclofen 5 mg by mouth every 12 hours, with hiccups greatly reduced in both intensity and frequency. Hiccups ceased 1 day after discharge. Eighteen days after surgery, he was off all medication with no return of his hiccups; 1 month later he remains hiccup free. CONCLUSIONS: Persistent hiccups have many postulated causes, including several that are common in the perioperative period, but this is the first time to our knowledge that persistent hiccups have been described in association with attempted interscalene brachial plexus block.
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6/12. Chronic hiccups.

    patients with chronic hiccups should be carefully examined for an underlying disorder while receiving symptomatic treatment. Treatment includes physical maneuvers, drugs such as chlorpromazine, metoclopramide, anticonvulsants or quinidine, and other, less tested modalities such as hypnosis. Only those patients with disabling hiccups that do not respond to conservative treatment should be considered for phrenic nerve surgery.
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7/12. Hiccups: an unusual manifestation of an abdominal aortic aneurysm.

    A patient with hiccups was found to have an abdominal aortic aneurysm that subsequently ruptured. We believe that a leaking abdominal aortic aneurysm led to an ileus-induced distention of the splenic flexure of the colon with consequent diaphragmatic irritation and phrenic nerve stimulation. This led to persistent hiccups as a result of repetitive stimulation of the reflex arc mediating hiccups. Persistent hiccups require investigation for an underlying organic etiology, and a leaking abdominal aortic aneurysm should be included in the differential diagnosis.
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8/12. phrenic nerve stimulation (diaphragm pacing) in chronic singultus.

    The authors implanted a diaphragm pacer in a 71-year-old man who had suffered for two years from continuous hiccup of unknown cause with resulting insomnia. Preoperative transcutaneous stimulation of the phrenic nerves in the neck resulted in diaphragm contractions but did not affect his hiccup. Postoperatively, the patient was free of symptoms for two weeks. Electrophrenic stimulation was then initiated and after three days his hiccup disappeared again. After a ten day period without stimulation his hiccup recurred. For ten months the patient has suffered from hiccup only in the day time during which time he has also used the pacer. With a few exceptions he has been free of symptoms and without pacing during the night, which enables him to sleep normally. The effect of phrenic nerve stimulation on hiccup could be due to interference with the abnormal activation of the phrenic nerve, whatever its cause.
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9/12. Intractable hiccups. (singultus).

    Intractable hiccups (singultus) is an uncommon disorder with various etiologies. The majority of reported studies of intractable hiccups has claimed ipsilateral spasm of the hemidiaphragm based solely on clinical or radiographic evidence. A case of intractable hiccups is presented. documentation of normal phrenic nerve latencies with bilateral synchronous firing of anterior scalene, intercostal muscles and bilateral hemidiaphragm involvement is presented. This combination of muscle group involvement supports the concept of a "supraspinal hiccup center." A systematic trial of chemotherapeutic agents described as effective against hiccups was employed. Relief lasting for three to four week periods has been obtained by the intravenous administration of a specially prepared sterile solution of methylphenidate. The nerve pathways pertinent to hiccup are discussed. The etiology of intractable hiccups and the various treatment modalities are presented.
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10/12. Intractable singultus: a diagnostic and therapeutic challenge.

    hiccup or singultus is a repeated involuntary, spasmodic contraction of the diaphragm accompanied by a sudden closure of the glottis mediated by sensory branches of the phrenic and vagus nerves as well as dorsal sympathetic afferents. The principle efferent limb and diaphragmatic spasms are mediated by motor fibers of the phrenic nerve. hiccup has been classified as a respiratory reflex and the central connection probably consists an interaction among the brainstem respiratory centers, phrenic nerve nuclei, medullary reticular formation and the hypothalamus. Chronic intractable hiccup may be due to brainstem seizures, and baclofen may be the long-awaited remedy for intractable hiccup as demonstrated in three illustrative cases.
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keywords = nerve
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