Unrelenting Hiccups as a Clue: Area Postrema Syndrome in Medullary Infarct – Two Case Reports

Background: The area postrema, a medullary circumventricular organ lacking a blood-brain barrier, plays a key role in autonomic regulation. Ischemic area postrema syndrome (APS) is rare but presents with intractable nausea, vomiting, and hiccups. Objectives: To highlight ischemic APS through two clinical cases and emphasize diagnostic and therapeutic considerations. Methods: Two male patients presented with persistent hiccups, nausea, and vomiting. Imaging confirmed lateral medullary infarcts involving the area postrema. Etiological investigations included vascular imaging and thrombophilia workup. Results: Case 1 had a vertebral artery thrombus and hyperhomocysteinemia. Case 2 showed a similar infarction with protein C and S deficiency. Both were treated conservatively with antiplatelets, vitamins, and symptomatic management, improving clinical outcomes. Conclusion: Ischemic APS should be considered in stroke differentials with unexplained emetic symptoms. Early recognition and targeted therapy can improve outcomes, particularly in patients with underlying prothrombotic states.