Clinical Reasoning: A 44-year-old man with a 3-month history of hiccups

Abstract

A 44-year-old right-handed African American man with a 1-year history of seizures was admitted for further evaluation. During a previous hospitalization for status epilepticus, MRI revealed a brain lesion, but the patient refused biopsy. Over a 3-month period, he developed unrelenting hiccups which fluctuated in frequency. His only other symptom was headache relieved by acetaminophen. The patient denied photophobia, phonophobia, and visual changes associated with the headache.