ABSTRACT
Background: Hiccups is a known presentation of lateral medullary infarction. However, the region in the medulla associated with this finding is not clearly known. In this study, we aimed to study the neural correlates of hiccups in patients with lateral medullary infarction (LMI). Methods: This retrospective study included all patients who presented with lateral medullary infarction between January 2008 and May 2018. Patients with hiccups following LMI were identified as cases and those with no hiccups but who had LMI were taken as controls. The magnetic resonance imaging of the brain was done viewed and individual lesions were mapped manually to the template brain. Voxel-based lesion-symptom mapping employing nonparametric permutation testing was performed using MRIcron. Results: There were a total of 31 patients with LMI who presented to the hospital during the study period. There were 11 (35.5%) patients with hiccups. Using the voxel-based lesion-symptom mapping analysis, the dorso-lateral region of the middle medulla showed significant association with hiccups. Conclusion: In patients with LMI, we postulate that damage to the dorsolateral aspect on the middle medulla could result in hiccups.
ABSTRACT
Methemoglobinemia is an altered state of hemoglobin resulting in impaired oxygen delivery to the tissues. Deliberate ingestion of certain insecticides and pesticides may result in this condition. We report a case of severe methemoglobinemia after deliberate ingestion of an insecticide marketed to be safe and containing only biological extracts and fillers. Methemoglobinemia should be suspected with low oxygen saturation on pulse oxymetry and the presence of chocolate colored blood. The methemoglobin level of 91% in our patient is the highest level reported among methemoglobinemia survivors.
