Beyond Face Drooping: Persistent Hiccups May Signal Severe Stroke

Neurologist Hsieh Pei-chen stated that in addition to the "5Ds" of stroke symptoms, persistent hiccups may indicate that the lesion is highly likely to spread to surrounding areas or cause compression, signifying that the reticular structure in the dorsal medulla has been disturbed. The image is a situational photo, and the person in the photo is unrelated to the article.

(Image taken from freepik)

[Health Channel] Single-sided limb weakness, slightly unsteady gait, and slurred speech. Neurologist Hsieh Pei-chen once encountered a patient who, while hospitalized, developed persistent hiccups and couldn't sleep. A nurse noticed this and realized something was wrong, suspecting it might be a "5Ds" stroke symptom.

Hsieh Pei-chen shared on her Facebook page "Pei Pei Physician Pain Reliever Neurology" that many people believe facial drooping is the only precursor to a stroke. However, persistent hiccups are actually related to lesions in the Area Postrema (AP), the most caudal part of the brainstem.

The "5Ds" stroke symptoms are as follows:

● Dizziness ● Dysarthria (significant slurred speech) ● Dysmetria (impaired distance judgment) ● Drop attack (sudden loss of strength) ● Diplopia (double vision)

58-year-old Mackay Memorial Hospital emergency physician Cheng Pi-fang recalled having a stroke while on duty last year (2025). He suddenly felt numbness in his left shoulder, which he described as rapidly spreading to his left upper limb, left lower limb, and left face. "Within minutes, the brain felt like it was having a power outage, shutting down section by section."

65-year-old well-known manager Sun Der-rong experienced clear stroke precursors such as limb weakness, slurred speech, facial drooping, and excessive drooling. He later revealed that his blood pressure had soared to 203, and he had difficulty walking and experienced dizziness.

Hsieh Pei-chen pointed out that some patients exhibit another symptom: persistent hiccups. The Area Postrema (AP) in the brainstem is located in the dorsal part of the Medulla Oblongata, adjacent to the floor of the fourth ventricle. Although it primarily functions as the chemoreceptor trigger zone (CTZ), it is surrounded by crucial neural nuclei:

● Nucleus Tractus Solitarius (NTS): This is the core of the autonomic nervous system, responsible for regulating cardiovascular responses, respiratory rhythm, and gastrointestinal activity. ● Nucleus Ambiguus: Controls swallowing and vocalization. ● Respiratory Regulation Center: The neural network within the medulla oblongata is responsible for controlling autonomous breathing.

When stroke precursors like limb weakness and slurred speech are accompanied by persistent hiccups, Hsieh Pei-chen stated that the lesion is highly likely to spread to surrounding areas or cause compression, indicating that the reticular structure in the dorsal medulla has been disturbed. This could lead to acute respiratory failure, severe arrhythmia, or drastic blood pressure fluctuations at any moment.

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