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Lateral medullary ischemia presenting with persistent hiccups and vertigo
Marco Mandalà1, Alessandra Rufa, Alfonso Cerase
1ENT Department, University of Verona, Verona, Italy. marcomand@hotmail.com
The International Journal of Neuroscience
|April 9, 2010
Summary
Lateral medullary ischemia (LMI) can present with unusual symptoms like persistent hiccups and vertigo. Early diagnosis of this rare LMI variant is crucial to prevent delayed treatment.
Area of Science:
- Neurology
- Vascular Neurology
- Neuro-ophthalmology
Background:
- Lateral medullary ischemia (LMI) is a type of stroke affecting the brainstem.
- Typical symptoms include vertigo, dysphagia, and dysarthria.
- Uncommon presentations of LMI can delay diagnosis and treatment.
Observation:
- A 65-year-old male presented with persistent hiccups, followed by disabling vertigo and lateropulsion.
- Examination revealed horizontal head-shaking-induced contralesional nystagmus (HSN).
- Neuroimaging confirmed subacute ischemic lesions in the right lateral medulla and cerebellum, with vertebral artery stenosis.
Findings:
- The patient's symptoms resolved after anticoagulation and endovascular stenting of the vertebral artery stenoses.
- Persistent HSN was noted post-treatment.
- The clinical presentation mimicked a benign labyrinthine disorder.
Implications:
- This case highlights an unusual clinical variant of LMI presenting with hiccups and vertigo.
- Recognizing this pattern is vital for timely intervention in stroke patients.
- Prompt diagnosis and treatment can prevent long-term neurological deficits.
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