Bulbar compression due to vertebrobasilar artery doliohectasia causing persistent hiccups in a patient successfully treated with diuretics and corticosteroids

Vertebrobasilar artery dolichoectasia is rarely syntomatic. The reported clinical manifestation include sign of cranial nerve or brain stem compression. These complications typycally develop when the basilar artery is elongated or ectasic and lies laterally to the margin of the clivus or dorsum sellae thus leading to bulbar compression. Persitent hiccups is a rare condition frequently associated with esophagogastric irritational noxae, chest tumors or cerebral expanding lesion in posterior fossa. When we have ruled out systemic (peripheral) causes, patiens presenting with cronic persistent hiccups should undergo non invasive brain imaging (angioCT- MR) to rule out possible underlying encephalic causes requiring tailored therapy.