Answer: Protrusion of vagus nerve stimulator leads 

• Vagus nerve stimulators (VNS) are primarily used in patients with refractory epilepsy to prevent seizures.
• The battery-powered generator is implanted in the lateral neck with leads surgically placed at the left vagus nerve.
• It is theorized to reduce seizure activity via stimulation of the afferent and efferent vagal fibers to seizure-generating brain regions and cause cortical inhibition via GABA neurotransmitters. In addition, VNS devices are theorized to affect the hiccup reflex arc involving the vagus and phrenic nerves to minimize hiccups although this has only been reported in case studies.
• Complications include hoarseness, coughing, and implant site infection. This patient underwent surgery with successful extraction of his leads.