title: A case of sinus arrest and post-hiccup cough syncope in medullary infarction.
abstract: We describe asymptomatic sinus arrest and post-hiccup cough syncope in a patient with medullary infarction. A 78-year-old woman developed arrhythmia, hiccup, and cough syncope attacks. Neurological examination was not remarkable. Cough syncope occurs after hiccup attacks. Bradycardia and decreased blood pressure were also present after the beginning cough. Holter 24-hour electrocardiography monitor exhibited 65 episodes of asymptomatic sinus arrest more than 3 seconds. Magnetic resonance imaging disclosed acute infarction in the bilateral medial regions and the right tegmentum of the upper and middle medulla oblongata. Cerebral angiography showed severe atherosclerotic changes in the vertebral arteries. These clinicoradiological findings suggested that a distinct topography of medullary lesions could cause a series of cardiovascular and respiratory dysfunction. Thus, physicians should pay more attention to the medullary lesion in patients with arrhythmia and syncope.
authors: Department of Neurology, Toho University Omori Medical Center, Omorinishi, Otaku, Tokyo, Japan.
authors: Takanori
authors: T
authors: Takazawa
authors: Department of Neurology, Toho University Omori Medical Center, Omorinishi, Otaku, Tokyo, Japan. Electronic address: keni@med.toho-u.ac.jp.
authors: Ken
authors: K
authors: Ikeda
authors: Department of Neurology, Toho University Omori Medical Center, Omorinishi, Otaku, Tokyo, Japan.
authors: Osamu
authors: O
authors: Kano
authors: Department of Cardiology, Toho University Omori Medical Center, Omorinishi, Otaku, Tokyo, Japan.
authors: Takayuki
authors: T
authors: Kabuki
authors: Department of Neurology, Toho University Omori Medical Center, Omorinishi, Otaku, Tokyo, Japan.
authors: Kiyokazu
authors: K
authors: Kawabe
authors: Department of Neurology, Toho University Omori Medical Center, Omorinishi, Otaku, Tokyo, Japan.
authors: Yasuo
authors: Y
authors: Iwasaki
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D001794:Blood Pressure; D001919:Bradycardia / Q000209:etiology; D020526:Brain Stem Infarctions / Q000150:complications* / Q000175:diagnosis; D002533:Cerebral Angiography; D003371:Cough / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006606:Hiccup / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D054138:Sinus Arrest, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013575:Syncope / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Hiccup; bradycardia; cough syncope; decreased blood pressure; medulla oblongata; sinus arrest; tegmentum