Surprising someone who has the hiccups sometimes helps these thoroughly irritating diaphragm spasms go away, but unfortunately for one man, the surprise was that his persistent hiccups were down to a tumor.
Described in BMJ Case Reports, a 35-year-old man in the U.S. visited a hospital in New York twice in one month with bouts of hiccups that wouldn’t go away. He was offered an antipsychotic drug called chlorpromazine, which is also commonly used to relieve persistent hiccups, but unfortunately it didn’t work. Upon return the following month, he presented with hiccups that had lasted for five days straight, alongside vomiting.
He told his doctors he’d also been suffering from tingling sensations, or paraesthesias, along his left side, which had previously been attributed to a slipped disc. Upon physical examination, his team spotted several tell-tale signs that something was likely going on with his nervous system.
He was given a simple test to look for weakness in his upper motor, or movement, neurons, which asks patients to hold their arms out in front of them, palms up, with their eyes shut. If one falls, it indicates a problem. In this case, his left side began to drift. He also had numbness in his left side and couldn’t walk properly due to balance problems.
A subsequent CT scan then revealed something much more sinister than an annoying case of hiccups: a mass of tissue with an associated cystic structure that extended from the fourth ventricle of his brain, near the cerebellum, all the way down to the seventh cervical vertebra in his neck.
The man was then sent into the operating theater pronto, in which surgeons removed a “grossly orange” tumor located at his second cervical vertebra, and the large cyst which was going throughout the majority of his cervical spine. Lab tests showed that the mass was a haemangioblastoma, a rare, slow-growing tumor that originates in the blood vessels of the brain and spinal cord.
The man was released four days later and, three months on, there was no recurrence, not of the tumor nor his persistent hiccups.
While hiccups can be attributed to a range of causes, in this case the authors note that it was due to the tumor stimulating or irritating the nerves that make up the so-called “hiccup reflex arc.”
"The tumor was pressing on the roots of the nerves in the cerivical spine," lead author Dr. Mark Goldin told IFLScience. "The same nerve roots that eventually coalesce into the nerves that go to the diaphragm and trigger hiccups.
"This particular type of tumor is most often benign," he added, "but the problem it causes is simply because of its size – what is called the mass effect. It's a mass compressing things. Physically cutting it out will get tid of the problem."