J Korean Neurosurg Soc.  2014 Jun;55(6):379-382. 10.3340/jkns.2014.55.6.379.

Intractable Hiccup as the Presenting Symptom of Cavernous Hemangioma in the Medulla Oblongata: A Case Report and Literature Review

• Lee KH
• Moon KS
• Jung MY
• Jung S

• KMID: 2191122
• DOI: http://doi.org/10.3340/jkns.2014.55.6.379

Abstract

A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem.

Keyword

Brainstem; Cavernous hemangioma; Hiccup; Medulla oblongata; Surgery

MeSH Terms

Adult
Brain Stem
Diagnosis
Hemangioma, Cavernous*
Hiccup*
Humans
Medulla Oblongata*
Pathology

Figure

• 

  Fig. 1 Preoperative MRI. A : Axial T2-weighted image shows a nodular lesion in the left sided cervicomedullary junction, with marked hyposignal intensity containing internal foci of hypersignal intensity. Sagittal pre- (B) and post- (C) gadolinium T1WI images show a non-enhancing cavernous hemangioma surrounded by bright hypersignal intensity halo which is consistent with blood products. D : An associated small developmental venous anomaly (arrow) is visualized in superior aspect of the cavernous hemangioma on axial post-gadolinium T1WI image.

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  Fig. 2 Peroperative photographs (A) demonstrating slightly bulged medulla oblongata with superficial abnormal draining vein (arrow). Note that the mass was located caudally to obex and removed using hemosiderin plane between hemangioma and normal parenchyme (B and C). *: obex.

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  Fig. 3 Microscopic findings of the medullary cavernous hemangioma. Histopathologic exam reveals a typical cavernous hemangioma with irregularly dilated vascular spaces. The vascular walls are accompanied by cautery artifacts (hematoxylin-eosin, original magnification, ×200).

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