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Fatal posterior circulation stroke with persistent hiccups, sinus arrest, and post-hiccup syncope (DWI) (1)

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Diffusion-weighted imaging, showing a high-intensity signal involving the left middle cerebellar peduncle, in a 58-year-old woman with fatal posterior circulation stroke with persistent hiccups, sinus arrest, and post-hiccup syncope. Post-hiccup syncope occurred after a hiccup episode of 5 to 10 seconds. The pathogenesis of post-hiccup syncope was considered similar to that of cough syncope: when bouts of either coughing or hiccups occur, the rise in intrathoracic pressure acutely lowers venous return and cardiac output, leading to a decrease in cerebral perfusion and loss of consciousness. (Source: Zhang N, Liang H, Wang X, Wang H. Fatal posterior circulation stroke with persistent hiccups, sinus arrest and post-hiccup syncope: a case report. Medicine (Baltimore) 2023;102(7):e33053. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)