# Sodium channel blockers as add-on treatment for unexplained refractory chronic cough: a case report and review

## TL;DR

A patient with chronic cough unresponsive to standard treatments improved with anticonvulsants, possibly due to a rare vascular issue.

## Contribution

Highlights a rare case linking internal jugular vein ectasia to chronic cough and successful treatment with sodium channel blockers.

## Key findings

- A 62-year-old woman with chronic cough showed improvement with carbamazepine and codeine.
- Cervical CT revealed right internal jugular vein ectasia as a potential trigger for neuropathic cough.
- The case suggests anticonvulsants may be effective for unexplained chronic cough linked to vascular anomalies.

## Abstract

Chronic cough is a common symptom with multiple causes, predominantly respiratory, gastroesophageal, or neurological. However, in rare cases, a vascular anomaly, such as internal jugular vein ectasia (IJVE), may function as a trigger. We report the case of a patient with paroxysmal chronic cough associated with right internal jugular vein ectasia, which responded favorably to anticonvulsant therapy.

We present the case of a 62-year-old female patient with pulmonary, cardiovascular, and neurological comorbidities, with a two-year history of daily episodes of severe, non-productive cough, refractory to standard symptomatic treatments. ENT, pulmonary, and gastroenterological evaluations did not identify a specific organic cause. The neurological examination was unremarkable, with no cranial nerve deficits. Cervical CT with contrast revealed a fusiform right internal jugular vein ectasia (IJVE) (area of 2.11 cm2 compared to the left side, 0.50 cm2). A chronic neurogenic cough possibly linked to the IJVE was suspected, and treatment with carbamazepine (300 mg three times daily) and codeine (15 mg four times daily) was successful in near-complete cough suppression.

This case adds to the emerging evidence regarding a possible link between IJVE and chronic neuropathic cough. Although rare, this etiology should be considered in chronic cough syndromes without an apparent cause. Neuropathic cough is underdiagnosed and may benefit from anticonvulsant treatment, while the identification of atypical mechanisms requires a multidisciplinary approach.