An Investigation of Hiccups

This previously healthy dextral 17-year-old boy presented with migrating paresthesia, pain at the posterior hairline, and intractable hiccups over four weeks. An evaluation for infections and inflammatory disorders was unremarkable, as was his head computed tomography. Physical examination was notable for a right pronator drift, weakness and numbness of right fifth digit flexion and arm flexion, and diminished sensation of the distal right lower extremity and fourth and fifth fingers. Full neuraxis magnetic resonance imaging (Fig) demonstrated a hemorrhagic cervicomedullary lesion extending from the medulla to C4-C5, 9.5 cm × 1.7 cm × 1.9 cm. The differential diagnosis included arteriovenous malformation, cavernous malformation, and neoplasm. Neck magnetic resonance angiography was normal.