1.Parkinsonism and intractable hiccup in a patient with relapsing sarcoidosis
Shiroh Miura ; Kazuhito Noda ; Akihiro Ouchi ; Nobutaka Edakuni ; Mitsuyoshi Ayabe ; Toshi Abe ; Hisamichi Aizawa ; Takayuki Taniwki
Neurology Asia 2010;15(2):189-192
We describe a 56-year-old man with relapsing sarcoidosis who presented with persistent hiccup
responsive to steroid and clonazepam treatments. The patient also showed parkinsonism. The interval
between the initial presentation and current symptoms was about 30 years. Brain MRI demonstrated
foci of abnormal signal intensity in the cerebral white matter bilaterally, with decreased signal
intensity on T1-weighted imaging and increased signal intensity on T2-weighted, diffusion-weighted,
and FLAIR images. Gadolinium-enhanced MRI of the brain showed diffuse linear enhancement
throughout the cerebral white matter with a confi guration suggesting perivascular infi ltration. Spinal
MRI revealed spotty gadolinium-enhancing lesions from C2 to T3 segments. This case suggests that
in some sarcoidosis patients intractable hiccup may be associated with high spinal cord lesions and
parkinsonism with frontal white matter lesions.
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