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Hiccups can herald MS. (Case Study).

SAN ANTONIO -- A 34-year-old man who came to the Mayo Clinic in Rochester, Minn., with a 30-day history of intractable hiccups with no apparent gastrointestinal cause was found to have multiple sclerosis following a work-up by the consultation-liaison psychiatry service, Dr. Ximena Sanchez Samper reported at the annual meeting of the Academy of Psychosomatic Medicine.

The patient's hiccups were associated with retching and nausea. He lost 30 pounds within a month and had been hospitalized twice for dehydration. The GI service focused on searching for an intraabdominal pathology but also referred the patient to the psychiatry service to rule out a psychogenic cause.

"There was nothing suggestive of anything psychiatric in origin," said Dr. Sanchez Samper, a third-year resident in psychiatry, in an interview with this newspaper. "He was genuinely concerned about his hiccuping, which is far from la belle indifference that a patient with a conversion disorder would give you.

Four days after admission, the patient exhibited Lhermitte's sign, which is suggestive of multiple sclerosis (MS). Recognizing that the brainstem is part of the hiccup reflex arc, Dr. Sanchez Samper requested an MRI to rule out a demyelinating lesion.

Following patient complaints of left monocular visual disturbance compatible with retrobulbar optic neuritis, an MRI scan with and without gadolinium revealed scattered T2 foci and a T2 signal enhancement in the left optic nerve, the right parietal subcortical area, the central medulla, and the spinal cord at the C4 level. A diagnosis of MS followed.

A review of the literature has revealed two other cases in which hiccups were a presenting symptom of MS, Dr. Sanchez Samper said.
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Article Details
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Title Annotation:multiple sclerosis
Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2002
Previous Article:Nonepileptic spells often marked by examples of reprise phenomenon. (Seizure or Pseudoseizure?).
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