Recurrent hiccups associated with ipsilateral intracerebral hemorrhage and chronic subdural hematoma with immediate resolutions after evacuations

Abstract

A 74-year-old man presented with persistent hiccups and headache persisting for 2 days. An anticoagulant was administered for his coronary heart disease. Cranial computed tomography (CT) revealed an intracerebral hemorrhage (ICH) located in the right occipital lobe, without any abnormal findings around the brainstem. The patient underwent endoscopic hematoma evacuation via a burr hole, resulting in immediate resolution of hiccups. Following an uneventful postoperative course, the patient experienced recurrent hiccups on the 47th day postsurgery. A subsequent CT scan taken on the 50th day revealed a compressive chronic subdural hematoma (CSDH) situated in the right frontoparietal convexity. The patient underwent burr-hole irrigation, leading to prompt cessation of the hiccups. Persistent hiccup should be recognized as potential manifestation of supratentorial lesions, including ICH or CSDH. Surgical evacuation of such lesions can rapidly alleviate hiccups associated with these pathologies.

Keywords: Central hiccup; Chronic subdural hematoma; Intracerebral hemorrhage; Intracranial pressure.

Fig. 1

Noncontrast axial computed tomography scans at the level of the foramen of Monro (A) and body of the lateral ventricle (B), performed at the initial presentation, depict a 33 × 24 × 43 mm intracerebral hemorrhage in the right occipital lobe, accompanied by ventricular perforation. (C) Contrast-enhanced sagittal computed tomography scan reveals no abnormal findings around the brainstem (arrow).

Fig. 2

Noncontrast axial computed tomography scan on the 40th postoperative day demonstrates complete resolution of intracerebral and intraventricular hemorrhages. In addition, thin subdural fluid accumulation is evident in the right frontal convexity (arrows). Arrowhead: burr-hole.

Fig. 3

Noncontrast axial computed tomography scans at the level of the lower anterior horn (A), body of the lateral ventricle (B), and centrum semiovale (C), performed on the 50th postoperative day, reveal compressive chronic subdural hematoma in the right frontoparietal convexity, measuring 23 mm in maximal thickness. The hematoma mostly appears isodense, with accompanying fluid-to-fluid levels (arrows).

Fig. 4

Noncontrast axial computed tomography scan taken on the day following burr-hole irrigation displays satisfactory removal of the subdural hematoma. Arrows: subdurally placed drain during surgery.