[Medullary tegmentum lesion in a patients having intractable hiccups, nausea, and syncope]

A 61-year-old female, having intractable hiccups, nausea, and syncope. Her systolic blood presure decreased by 30 mmHg on sitting position from supine position. Sinus arrest lasting more than three seconds were detected 52 times per day by 24 hour Holter electrocardiography. Brain MRI disclosed a small hyperintense lesion in the medullary tegmentum on T2-weighted images. She was diagnosed as having a relapse of multiple screlosis and her symptoms were improved by administration of high dose methylprednisolone (1,000 mg per day x 3 days) intravenously. In a patients, a stimulative lesion in the medullary tegmentum was suspected where the reflex centers of hiccups, nausea and blood pressure to exist. We are able to confirm a small hyperintense lesion in such a particular region by brain MRI. In case of syncope accompanied with intractable hiccups and nausea, we should consider a stimulative lesion in the medullary tegmentum. Moreover, sinus arrest other than orthostatic hypotension may be involved in the pathophysiology of syncope in correlation with the medullary tegmentum lesion.