title: Medullary neurosarcoidosis presenting with intractable hiccoughs.
abstract: Hiccoughs (singultus) are a complex physiological process characterized by sudden brief involuntary contractions of the diaphragm. They most commonly occur from peripheral mechanisms that result in diaphragmatic irritation, but also occur from brain stem lesions such as that seen in Wallenberg's syndrome. They are uncommon in sarcoidosis and it is remarkably rare when hiccoughs are the presenting symptom of neurosarcoidosis. We report a patient with sarcoidosis who presented with intractable hiccoughs due to an inflammatory medullary lesion. Evaluation revealed an enhancing lesion in the dorsomedial medulla that resolved after aggressive immune-modulating therapy. In the absence of a clear peripheral lesion that would potentially affect the diaphragm, the diagnosis of neurosarcoidosis involving the brainstem should be considered in patients with sarcoidosis.
authors.affiliation: Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA. johns@ccf.org
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.forename: Joseph
authors.initials: J
authors.lastname: Parambil
authors.forename: Daniel
authors.initials: D
authors.lastname: Culver
authors.forename: Jinny
authors.initials: J
authors.lastname: Tavee
mesh_terms: D002493:Central Nervous System Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D006606:Hiccup / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D011859:Radiography; D012507:Sarcoidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D015898:Tomography Scanners, X-Ray Computed