Abstract 064: A Strategic Infarct Involving Internal Capsule and Globus Pallidus Causing Sudden Onset Dementia with Persistent Hiccups: A Case Report

• Published in: Stroke: vascular and interventional neurology Vol. 4; no. S1
• Main Authors: Aggarwal, A, Akinci, Y, Strauss, S
• Format: Journal Article
• Language: English
• Published: Phoenix Wiley Subscription Services, Inc 01-11-2024
• Subjects: Cardiovascular disease; Case reports; Cognition & reasoning; Dementia; Ischemia
• ISSN: 2694-5746; 2694-5746
• DOI: 10.1161/SVIN.04.suppl_1.064

IntroductionStrategic infarct dementia is a rare subtype of vascular dementia caused by a single infarct in a region of the brain involved in cognition, rather than a series of small infarcts. The internal capsule and globus pallidus are amongst those strategic regions as evidenced by prior case studies. Hiccups have central and peripheral causes. The main central neuro‐anatomical centre is presumed to be the medulla oblongata but some studies have shown supratentorial strokes causing hiccups as well. Hiccups secondary to an infarct in the globus has been shown in one prior case report and another case report showed development of hiccups in a patient with an infarct in the posterior limb of the internal capsule. Globus pallidus damage causing hiccups has also been reported in a case of posteroventral pallidotomy in a Parkinson's disease patient.Case ReportA 76‐year‐old right‐handed male with diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease presented to our hospital with 5 days of persistent sudden onset hiccups and confusion. Per family patient's baseline cognition function was within normal limits. Neurological examination was significant for apathy, disorientation to date and month, slight delay in responses and difficulty with performing complex commands. Patient also had slight weakness (4/5 strength) in the left arm. His Mini‐Mental state Exam Score was 9/30. Labs were significant for an elevated blood glucose level (361 mg/dl). Head computed tomography (CT scan) showed right basal ganglia focal low attenuation. CT angiography was unremarkable. Magnetic Resonance Imaging (MRI) without contrast confirmed acute to subacute right internal capsule genu infarct with extension to globus pallidus interna and externa and chronic mild white matter microangiopathic ischemic changes (Figure 1). Routine electroencephalogram did not show any epileptiform discharges or focal slowing. Patient's cognitive dysfunction did not improve during his six‐day hospital course despite correction of his blood glucose levels. Patient was started on Gabapentin 100 mg three times a day for his hiccups which resulted in significant improvement.ConclusionOur patient's sudden onset of dementia symptoms and hiccups likely developed secondary to his acute internal capsule and/or globus pallidus infarct. The patient may have had prior subclinical decline in his cognitive functions secondary to co‐existing chronic small vessel ischemic changes which was not recognised by the family. Persistent and intractable hiccups can be debilitating and require quick and effective treatment.