Yonsei Med J.  2005 Apr;46(2):292-295. 10.3349/ymj.2005.46.2.292.

Pneumomediastinum Due to Intractable Hiccup as the Presenting Symptom of Multiple Sclerosis

• Na SJ
• Lee SI
• Chung TS
• Choi YC
• Lee KY

• KMID: 1734058
• DOI: http://doi.org/10.3349/ymj.2005.46.2.292

Abstract

Pneumomediastinum and subcutaneous emphysema generally occurs following trauma to the esophagus or lung. It also occurs spontaneously in such situations of elevating intra- thoracic pressure as asthma, excessive coughing or forceful straining. We report here on the rare case of a man who experienced the signs of pneumomediastinum and subcutaneous emphysema after a prolonged bout of intractable hiccup as the initial presenting symptoms of multiple sclerosis.

Keyword

Pneumomediastinum; intractable hiccup; multiple sclerosis

MeSH Terms

Adult
Brain/pathology
Hiccup/*complications/etiology
Humans
Magnetic Resonance Imaging
Male
Mediastinal Emphysema/*etiology/radiography
Multiple Sclerosis/*complications/diagnosis
Subcutaneous Emphysema/etiology
Thoracic Vertebrae/pathology
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Chest CT shows pneumomediastinum and subcutaneous emphysema in the anterior mediastinum and right anterior chest wall.

• 

  Fig. 2 A-B. Sagittal and coronal T2 weighted Brain MRI shows a high signal intensity lesion (arrow) in the left side lower medulla oblongata and upper cervical cord. C. This lesion shows enhancement after gadolinium injection on T1 weighted brain MRI.

• 

  Fig. 3 T2 weighted spinal MRI shows a high signal intensity lesion (arrow) in the lower thoracic spinal cord.

Reference

1. Souadjian JV, Cain JC. Intractable hiccup: etiologic factors in 220 cases. Postgrad Med. 1968. 43:72–77.

2. Marsot-Dupuch K, Bousson V, Cabane J, Tubiana JM. Intractable hiccups: the role of cerebral MR in cases without systemic cause. AJNR Am J Neuroradiol. 1995. 16:2093–2100.

3. Nathan MD, Leshner RT, Keller AP Jr. Intractable hiccups (singultus). Laryngoscope. 1980. 90:1612–1618.

4. Koullias GJ, Korkolis DP, Wang XJ, Hammond GL. Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg. 2004. 25:852–855.

5. Jougon JB, Ballester M, Delcambre F, Mac Bride T, Dromer CE, Velly JF. Assessment of spontaneous pneumomediastinum: experience with 12 patients. Ann Thorac Surg. 2003. 75:1711–1714.

6. Park KW, Cheon SM, Hong SK, Choi SH, Cha JK. A case of intractable hiccups as presenting symptom of multiple sclerosis. J Korean Neurol Assoc. 2002. 20:195–198.

7. Funakawa I, Terao A. Intractable hiccups and syncope in multiple sclerosis. Acta Neurol Scand. 1998. 98:136–139.

8. Chang YY, Wu HS, Tsai TC, Liu JS. Intractable hiccup due to multiple sclerosis: MR imaging of medullary plaque. Can J Neurol Sci. 1994. 21:271–272.

9. Funakawa I, Hara K, Yasuda T, Terao A. Intractable hiccups and sleep apnea syndrome in multiple sclerosis: report of two cases. Acta Neurol Scand. 1993. 88:401–405.

10. McFarling DA, Susac JO. Hoquet diabolique: intractable hiccups as a manifestation of multiple sclerosis. Neurology. 1979. 29:797–801.

11. Al Deeb SM, Sharif H, Al Moutaery K, Biary N. Intractable hiccup induced by brain stem lesion. J Neurol Sci. 1991. 103:144–150.