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J Neurocrit Care 2009;2(1): 1-5.
급성 외측연수경색에서 난치성 딸꾹질의 임상적 특성과 국소화
고신대학교 의과대학 신경과학교실,1 신마산병원 신경과2
Clinical Feature and Localization of Intractable Hiccup in Patients with Acute Lateral Medullary Infarction
So-Young Huh, MD1, Bong-Goo Yoo, MD, PhD1 and Ji-Won Min, MD2
1Department of Neurology, Kosin University College of Medicine, Busan, Korea 2Department of Neurology, Ulsan Hospital, Ulsan, Korea
Background: Intractable hiccups are defined as hiccup persisting for more than 48 hours. The relationship between lesion location of lateral medullary infarction (LMI) and intractable hiccup is rarely reported. This study was designed to investigate the clinical characteristics and topographic patterns of intractable hiccups in the LMI.
Methods: We identified 9 patients with intractable hiccups by medical record, telephone interview and brain MRI between 1998 and 2003. LMI was diagnosed by clinical findings and brain MRI. MRI lesions were classified vertically as upper, middle and lower level and horizontally.
Results: All patients with intractable hiccups were men. The onset time of intractable hiccups was 3.8±2.7 days (range, 1-7 days). The duration of intractable hiccups was 15.1±8.9 days (range, 4-31 days). Vertically, three patients had lesions in the upper medulla, two patients had lesions in the upper and middle medulla, two patients had lesions in the all levels of the medulla, one patient had lesions in the middle medulla, and one patient had lesions in the middle and lower medulla. Horizontally, dorsolateral and/or midlateral lesions were always involved. All patients with LMI with intractable hiccup had vertigo/dizziness, nausea/vomiting and dysphagia.
Conclusions: These results demonstrate that intractable hiccups are frequent in men and related to the dorsolateral region of the middle and/or upper levels of medulla. We suggest that involvement of the nucleus ambiguous may be responsible for intractable hiccups.
Key Words: Hiccups·Lateral medullary infarction·MRI
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