BACKGROUND
Lateral medullary syndrome (LMS), better known as Wallenberg syndrome is a pattern of neurologic symptoms due to the tissue ischemia and necrosis of the lateral part of the medulla in the brain. This syndrome is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side.
Rarely LMS can resulting in violent and incoercible hiccups.1
Here we report a case of a patient with a LMS and intractable hiccup who was unweaned by mechanical ventilation until oral baclofen was administred.
CASE REPORT
A 50yearold man was admitted to emergency department with an impaired sensation over left half face vertigo, nystagmus, hiccups, nausea and vomiting. He was also dysphagic, with an impaired sensation over left half face, and contralateral hemibody. Due to the magnitude of the dysphagia and hiccups patient presented an aspiration pneumonia and as a result of respiratory failure required intubation. A further MRI showed an acute left sided dorsal lateral medullary infarct. However due to violent hiccups mechanical ventilation of the patient resulted impaired, requiring continuous curare
administration and impeding the weaning and extubation of the patient. The hiccups was intractable with the common metoclopramide, chlorpromazine, alprazolam, midazolam, omeprazole and gabapentin.
The patient reported resolution of hiccups 3 hours after 10 mg oral baclofen administration.
DISCUSSION
One of the symptoms that occur due to LMS syndrome are hiccups which involves 14% of patients.1The hiccups can be so severe that causes dysphagia, aspiration pneumonia and disadaptation to mechanical ventilation.Unfortunately there are very few successful medications available to mediate the inconvenience of constant hiccups.Baclofen, an analog of GABA, decreases the excitability and inhibits the hiccup reflex.
REFERENCES
M Park et al. Lesional location of lateral medullary infarction presenting hiccups. J Neurol Neurosurg Psychiatry. 2005;76: 958
LEARNING POINTS
Baclofen could be effective in treating persistent hiccups following LMS syndrome.

Baclofen as adjuvant to weaning from mechanical ventilation in a patient with intractable hiccup. A case report