Persistent hiccups after acute supratentorial stroke: Report of seven cases and review of literature

Persistent hiccups are hiccups that last for at least 48 h, and may occur following a legion of causes including strokes. They have been described following infarctive and hemorrhagic strokes. Hiccup is a respiratory reflex action that occurs following the sudden contraction of the diaphragmatic and intercostals muscles with closure of the glottis; and putatively believed to be a form of myoclonus (very brief repeated contractions of striated muscles) that occurs from irritation of the medullary mediated reflex arc that has supratentorial inputs. This underpins the association of hiccups with suprabulbar lesions like strokes, apparently following repeated excitatory inputs from the higher centers. Hiccups are ordinarily self-limiting, but persistent hiccups are advisedly treated with pharmacologic agents, of which baclofen, a GABA B agonist muscle relaxant has proven to be remarkably efficient. It is believed that the action of baclofen interrupts the hiccup reflex arc. Nonpharmacologic remedies like vagus nerve stimulation have also been found to be effective and may be complementary. This case series highlights the use of baclofen in persistent hiccups following supratentorial infarcts.