Hiccups as Herald: Neuromyelitis Optica Spectrum Disorder

Gastrointestinal symptoms were an early harbinger of serious neurologic disease. A 60-year-old man had already endured intractable hiccups for a year when he presented with new right upper extremity paresthesias that had started 1 week earlier. First, he experienced right-sided scalp tenderness with periaural tingling. This progressed to hyperesthesia of the right side of the face and then to hyperesthesia of the right upper extremity. The day prior to admission, he developed weakness of the right upper extremity. He had no weakness in the other extremities, bladder or bowel incontinence, visual disturbances, or weight loss.