Basilar artery aneurysm: an unusual cause of intractable hiccups

A70-year-old retired lorry driver was admitted as an emergency with a 2-day history of moderate amount of haematemesis, nausea, vomiting and intractable hiccups. He was a known hypertensive and 5 years previously had an episode of subarachnoid haemorrhage. Complications required the insertion of a Rickman reservoir shunt. Since the time of the subarachnoid haemorrhage, his hiccups had been almost constant despite taking chlorpromazine tablets 25 mg three times a day. On examination, he had intractable hiccups. Cardiovascular, respiratory and abdominal examination were normal. Neurological examination revealed a right-sided partial third nerve palsy (with ptosis and pupillary sparing). He also had a right-sided squint operation during childhood. More detailed examination of the cranial nerves revealed mild right-sided glossopharyngeal and hypoglossal nerve palsies. Routine full blood count, blood biochemistry, chest X-ray and abdominal ultrasound scan were normal. Upper gastrointestinal endoscopy revealed ...