Hiccups Post-Stroke: What You Need To Know

Hiccups are a common symptom after a stroke, and they can sometimes be persistent and constant. Strokes can disrupt the breathing centre in the brain, which can lead to hiccups. The hiccup reflex arc is thought to consist of an afferent pathway, the hiccup centre, and an efferent pathway. The main causes of hiccups can be classified as central nervous system, psychiatric, metabolic, toxic and infectious, ear, nose, and throat disease, thoracic, and abdominal. While time is typically the best cure for hiccups, recovering stroke patients are sometimes prescribed medication to treat their constant hiccups.

Hiccups can be a symptom of pulmonary embolism, which can be caused by a stroke

Hiccups are a common occurrence after a stroke, with some stroke patients reporting frequent or nonstop bouts of hiccups. Strokes can disrupt the breathing centre in the brain, which can lead to hiccups. While hiccups are usually temporary, they can sometimes be persistent and require medical intervention.

In rare cases, hiccups can be a symptom of a more serious condition called pulmonary embolism (PE). PE occurs when a blood clot travels to the lungs and can be life-threatening. It is the third leading cause of cardiovascular death and is often undertreated because people are unaware of its symptoms. Risk factors for PE include major surgery, hospitalisation, pregnancy, cancer, and long-distance travel.

There is a link between stroke and PE, as stroke patients are at an increased risk of developing blood clots, known as deep vein thrombosis (DVT). DVT can lead to PE if the clot travels to the lungs. In a study of 11,287 patients with acute ischemic stroke, 0.78% were found to have PE. The risk factors for PE in stroke patients include age, stroke severity, history of cancer, previous DVT/PE, or development of in-hospital DVT.

In one case study, a 66-year-old male who had suffered a posterior circulation stroke developed persistent hiccups. Initially, the hiccups were thought to be secondary to a central disorder. However, further evaluation revealed that the hiccups were a rare presenting symptom of PE. This case highlights the importance of including PE as a potential cause of persistent hiccups in stroke patients.

Strokes can disrupt the breathing centre in the brain, leading to hiccups

Hiccups are a temporary movement disorder that involves the coordination of your brain, spinal cord, nerves, and muscles. They occur when your diaphragm spasms and your glottis suddenly closes, producing a distinctive "hic" sound. Strokes can sometimes interfere with the breathing centre in the brain, resulting in hiccups.

The breathing centre in the brain is a complex network of neurons that controls and regulates our breathing. It is located in the brainstem, specifically in the medulla oblongata, and works in conjunction with other areas of the brain and body to ensure proper respiratory function. The phrenic nerve, which arises from the brainstem and travels down to the diaphragm, plays a crucial role in transmitting signals that control the rhythm of breathing.

During a stroke, blood flow to the brain is interrupted, resulting in oxygen deprivation to brain tissue. This can cause damage to the breathing centre in the brainstem, leading to a disruption in the normal respiratory rhythm and triggering involuntary spasms of the diaphragm, resulting in hiccups.

The impact of a stroke on the breathing centre can vary depending on the location and extent of the damage. In some cases, strokes may affect the vagus nerve or the phrenic nerve, which are both involved in the reflex arc that controls hiccups. Damage to these nerves can further contribute to the occurrence of hiccups.

While hiccups after a stroke are not uncommon, they can be persistent and require medical attention. In some cases, they may indicate an underlying condition, such as pulmonary embolism, which should be promptly diagnosed and treated.

Hiccups can be caused by supratentorial infarcts, including the insular cortex, temporal lobe, and subcortex

Hiccups are a temporary movement disorder that involves the brain, spinal cord, nerves, and muscles. They are caused by a spasm of the diaphragm and the sudden closure of the glottis, resulting in a noisy sound. Strokes can disrupt the breathing centre of the brain, leading to hiccups. While hiccups are usually cured by time, recovering stroke patients are sometimes prescribed medication to treat their constant hiccups.

Supratentorial infarcts can accompany hiccups in stroke patients. A study by Itabashi et al. (2019) found that out of 5,309 patients with acute ischemic stroke or transient ischemic attack, 16 had hiccups. Of these, nine patients had infarcts in the lateral medulla oblongata, while the remaining seven had supratentorial infarcts, including the insular cortex, temporal lobe, and subcortex. The right hemisphere was frequently damaged, accounting for 86% of the cases.

The study aimed to address the clinical and radiological characteristics of acute stroke patients who experienced hiccups caused by supratentorial lesions. The results suggest that hiccups could be caused by supratentorial infarcts, specifically those involving the insular cortex, temporal lobe, and subcortex.

The reflex arch for hiccups is thought to consist of an afferent pathway (phrenic nerve, vagus nerve, or sympathetic afferents), a hiccup centre, and an efferent pathway (primarily the phrenic nerve). While the exact neuroanatomical hiccup centre is unknown, it is believed to involve the brainstem, phrenic nerve nuclei, medullary reticular formation, and hypothalamus. Discontinuation of inhibitory control by cortical regions may affect the brainstem, resulting in altered sympathetic tone and hiccups.

Persistent hiccups may be caused by irritation of the reflex arc in the chest

Hiccups are a temporary movement disorder that involves the brain, spinal cord, nerves, and muscles. They occur when the diaphragm spasms and the glottis suddenly closes, producing a loud sound. Strokes can interfere with the brain's breathing centre, causing hiccups. Persistent hiccups can be caused by irritation of the reflex arc in the chest.

A reflex arc is a neural pathway that controls a reflex, allowing for faster reflex actions by activating spinal motor neurons without routing signals through the brain. It is a neurological and sensory mechanism that controls a reflex, an immediate response to a particular stimulus. The reflex arc consists of five components: receptor, sensory neuron, integration centre, motor neuron, and effector. The receptor is the location of stimulus action, and the sensory neuron transmits afferent impulses to the CNS. The integration centre, or synapse, connects the sensory and motor neurons. The motor neuron carries efferent impulses from the integration centre to an effector organ, and the effector is a gland cell or muscle fibre that responds to the efferent impulses via contraction or secretion.

In the context of hiccups, the reflex arc involves the brainstem, phrenic and vagus nerve, and sympathetic chain. When this reflex arc is irritated, it can lead to persistent hiccups. This irritation can be caused by pulmonary embolism (PE), which is a rare but possible cause of persistent hiccups in stroke patients.

While time is typically the best cure for hiccups, medications such as chlorpromazine or baclofen may be prescribed to treat constant hiccups in stroke patients. If the hiccups do not subside, it is important to locate and correct the underlying cause.

In some cases, stroke patients may need medication to treat constant hiccups

Hiccups are a common occurrence after a stroke, with some stroke patients suffering from constant or frequent bouts of hiccups. Strokes can disrupt the breathing centre of the brain, which can lead to hiccups. The diaphragm spasms, and the glottis suddenly closes, resulting in the familiar "hic" sound. While hiccups typically go away on their own, stroke patients may sometimes require medication to treat persistent hiccups.

In some cases, medication may be necessary to treat constant hiccups in stroke patients. Chlorpromazine is a medication that has been used to treat hiccups, but it can cause sedation that interferes with therapies. Baclofen is another drug that has been prescribed to treat hiccups, and it was successful in treating one patient. Haloperidol has also been used to manage hiccups in stroke patients. However, it is important to tailor the treatment to the unique circumstances of the patient, as each case may require a different approach.

The cause of the hiccups must be identified and addressed when they are persistent and do not go away on their own. The main causes of hiccups can be classified as central nervous system disorders, psychiatric issues, metabolic problems, toxic and infectious agents, ear, nose, and throat diseases, thoracic conditions, and abdominal issues. Identifying the underlying cause can help guide treatment and management.

In one case study, a 66-year-old male stroke patient developed persistent hiccups, which were thought to be secondary to a central disorder. The patient was prescribed chlorpromazine tablets, but the hiccups persisted. Further evaluation revealed that the patient had developed pulmonary embolism, a rare cause of persistent hiccups in stroke patients. The patient was started on low-molecular-weight heparin, and the hiccups eventually disappeared. This case highlights the importance of considering rare causes of persistent hiccups and the need for prompt diagnosis and treatment.

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