Printer Friendly

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.
COPYRIGHT 2002 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:multiple sclerosis
Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2002
Words:268
Previous Article:Nonepileptic spells often marked by examples of reprise phenomenon. (Seizure or Pseudoseizure?).
Next Article:Depression affects over one-third of epilepsy patients. (Avoid Bupropion).
Topics:


Related Articles
Lyme disease rarely seen as MS.
MRI quickly clinches multiple sclerosis diagnosis: new diagnostic guideline. (magnetic resonance imaging).
Quality of life for veterans with multiple sclerosis on disease-modifying agents: relationship to disability.
Depression and multiple sclerosis: review of a lethal combination.
Cognitive dysfunction in multiple sclerosis: assessment, imaging, and risk factors.
The effect of a combined exercise programme for people with Multiple Sclerosis: a case series.
Virus link offers hope of vaccine for multiple sclerosis.

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters