Fatal posterior circulation stroke with persistent hiccups, sinus arrest and post-hiccup syncope: A case report

Rationale:Diagnosis of posterior circulation stoke is difficult, and magnetic resonance imaging especially diffusion-weighted imaging is superior to computed tomography. Persistent hiccups, sinus arrest, and post-hiccup syncope are extremely rare symptoms of posterior circulation stroke. However, there is no effective treatment for persistent hiccup. Patient concern and diagnosis:We describe a case of a 58-year-old hypertensive woman diagnosed with acute posterior circulation stroke who presented with persistent hiccups, sinus arrest, and post-hiccup syncope. Diffusion-weighted imaging revealed a high-intensity signal involving the left middle cerebellar peduncle and several spotted areas in the right occipital lobe. Interventions:Permanent pacemaker was implanted and metoclopramide was used to treat persistent hiccups. Outcome:The patient developed aspiration pneumonia and morbid dysphoria, and eventually died. Lessons:Posterior circulation stroke can cause cardiovascular and respiratory dysfunction. Consequently, physicians should pay more attention to posterior circulation lesions in patients with arrhythmia and syncope. An effective method to treat persistent hiccups is urgently needed.