Hiccups due to Chiari type I malformation

Health

Hiccups due to Chiari type I malformation

Published

12 months ago

May 8, 2023

A 33-year-old man presented to our hospital with a 2-week history of dizziness and gait disturbance and a 7-day history of hiccups that persisted throughout the day accompanied by nausea and decreased appetite. The patient had no remarkable medical history, reported no medication or substance use and had no history of hiccups. On physical examination, muscle strength and tendon reflexes in the extremities were normal; however, we observed both dysmetria of the right hand and ataxic gait, indicative of a cerebellar disorder. Magnetic resonance imaging of the head showed displacement of the cerebellar tonsils below the foramen magnum level, with a syrinx extending from the C1 to T11 level (Figure 1). We diagnosed Chiari type I malformation and syringomyelia. The patient then underwent foramen magnum decompression including suboccipital craniectomy and C1 laminectomy. After surgery, he had gradual improvement in symptoms; after 2 months, his symptoms, including the hiccups, disappeared and the syrinx cavity size was reduced on follow-up imaging.

<a href=”https://www.cmaj.ca/content/cmaj/195/18/E652/F1.large.jpg?width=800&height=600&carousel=1″ title=”(A) Midsagittal T2-weighted magnetic resonance imaging (MRI) scan of the brain and brainstem of a 33-year-old man showing the cerebellar tonsils displaced into the upper cervical canal, 8 mm below the foramen magnum (basion-opisthion line, arrows), with slight caudal descent of the brainstem and effacement of cerebrospinal fluid space. Although retroflexion of the odontoid process, shortened clivus and small basilar invagination (the odontoid process lies 6.2 mm across the Chamberlain line) were observed, there was no compression of the brainstem. A cervical syrinx formation was also seen. (B) Midsagittal T2-weighted MRI scan of the thoracic spine showing a syrinx extending to the level of T11.” class=”highwire-fragment fragment-images colorbox-load” rel=”gallery-fragment-images-1532542063″ data-figure-caption=”

(A) Midsagittal T₂-weighted magnetic resonance imaging (MRI) scan of the brain and brainstem of a 33-year-old man showing the cerebellar tonsils displaced into the upper cervical canal, 8 mm below the foramen magnum (basion-opisthion line, arrows), with slight caudal descent of the brainstem and effacement of cerebrospinal fluid space. Although retroflexion of the odontoid process, shortened clivus and small basilar invagination (the odontoid process lies 6.2 mm across the Chamberlain line) were observed, there was no compression of the brainstem. A cervical syrinx formation was also seen. (B) Midsagittal T₂-weighted MRI scan of the thoracic spine showing a syrinx extending to the level of T11.

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Figure 1:

Chiari type I malformation is a hindbrain abnormality in which the cerebellar tonsils descend through the foramen magnum, with a radiological prevalence of 1%–3.6%.1 Frequently asymptomatic, it can present in children and adults with occipital headache, weakness or cerebellar signs. Hiccups are an uncommon presentation.2 Hiccups arise from stimulation or damage to the hiccups reflex arc, comprising the hypothalamus, brainstem, cervicothoracic spinal cord, vagal and phrenic nerves and respiratory muscles.2^,3 Both Chiari malformation and concomitant syrinx (a fluid-filled cavity involving the brainstem [syringobulbia] or spinal cord [syringomyelia]), can affect the hiccups reflex arc, leading to hiccups.2^,3 Syringomyelia is present in about 25% of patients with Chiari type I malformation.1 Although typically self-limiting, hiccups lasting longer than 48 hours may require investigation for an underlying cause.2^,3

Footnotes

Competing interests: None declared.
This article has been peer reviewed.
The authors have obtained patient consent.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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April 22nd to 30th is Immunization Awareness Week – Oldies 107.7

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4 mins ago

April 24, 2024

Harry Miller

<!–April 22nd to 30th is Immunization Awareness Week | Oldies 107.7

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AHS confirms case of measles in Edmonton – CityNews Edmonton

Published

1 hour ago

April 24, 2024

Harry Miller

Alberta Health Services (AHS) has confirmed a case of measles in Edmonton, and is advising the public that the individual was out in public while infectious.

Measles is an extremely contagious disease that is spread easily through the air, and can only be prevented through immunization.

AHS says individuals who were in the following locations during the specified dates and times, may have been exposed to measles.

April 16
- Edmonton International Airport, international arrivals and baggage claim area — between 3:20 p.m. and 6 p.m.
April 20
- Stollery Children’s Hospital Emergency Department — between 5 a.m. to 3 p.m.
April 22
- 66^th Medical Clinic (13635 66 St NW Edmonton) — between 12:15 p.m. to 3:30 p.m.
- Pharmacy 66 (13637 66 St NW Edmonton) — between 12:15 p.m. to 3:30 p.m.
April 23
- Stollery Children’s Hospital Emergency Department — between 4:40 a.m. to 9:33 a.m.

AHS says anyone who attended those locations during those times is at risk of developing measles if they’ve not had two documented doses of measles-containing vaccine.

Those who have not had two doses, who are pregnant, under one year of age, or have a weakened immune system are at greatest risk of getting measles and should contact Health Link at 1-877-720-0707.

Symptoms

Symptoms of measles include a fever of 38.3° C or higher, cough, runny nose, and/or red eyes, a red blotchy rash that appears three to seven days after fever starts, beginning behind the ears and on the face and spreading down the body and then to the arms and legs.

If you have any of these symptoms stay home and call Health Link.

In Alberta, measles vaccine is offered, free of charge, through Alberta’s publicly funded immunization program. Children in Alberta typically receive their first dose of measles vaccine at 12 months of age, and their second dose at 18 months of age.

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U.S. tightens rules for dairy cows a day after bird flu virus fragments found in pasteurized milk samples – Toronto Star

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2 hours ago

April 24, 2024

Harry Miller

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Infected cows were already prohibited from being transported out of state, but that was based on the physical characteristics of the milk, which looks curdled when a cow is infected, or a cow has decreased lactation or low appetite, both symptoms of infection.

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