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[Glossopharyngeal neuralgia associated with cardiac syncope in an octogenary patient]. Rev Esp Geriatr Gerontol 2022; 57:332-333. [PMID: 36280547 DOI: 10.1016/j.regg.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
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Yu H. Curious case of neck pain caused by glossopharyngeal neuralgia. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:509-512. [PMID: 35831098 PMCID: PMC9842137 DOI: 10.46747/cfp.6807509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Hana Yu
- Clinical Lecturer in the Faculty of Medicine and Dentistry at the University of Alberta in Edmonton.,Correspondence Dr Hana Yu; e-mail
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Blue R, Spadola M, McAree M, Kvint S, Lee JYK. Endoscopic Microvascular Decompression for Vagoglossopharyngeal Neuralgia. Cureus 2020; 12:e12353. [PMID: 33520548 PMCID: PMC7841968 DOI: 10.7759/cureus.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/17/2022] Open
Abstract
Glossopharyngeal neuralgia (GN) is a nerve compression syndrome that presents with episodes of unilateral sharp, stabbing pain in the distribution of the ninth cranial nerve. This syndrome may present with cardiac and autonomic manifestations - a condition termed vagoglossopharyngeal neuralgia (VGPN). Most cases of VGPN arise from neurovascular insult at the cerebellopontine angle. Conservative treatment for VGPN includes antiepileptic medications. Surgical treatments include trigeminal tractotomy-nucleotomy, Gamma Knife® stereotactic radiosurgery, radiofrequency thermocoagulation, rhizotomy, and, as shown in this paper, endoscopic microvascular decompression (E-MVD). In this article, we present two cases. Case 1 demonstrates a 53-year-old male with right-sided GN symptoms that began to experience syncopal episodes 10-years after the initial presentation. Case 2 presents a 61-year-old female with a history of Ehlers-Danlos syndrome, and the malignant vasovagal syndrome that became associated with painful, shooting left anterior neck spasms consistent with GN. Both patients underwent E-MVD, leading to complete relief of neuralgia and cardiac symptoms. Our outcomes support previously published reports of successful treatment of VGPN using microvascular decompression (MVD) and describe a purely endoscopic surgical technique. MVD is the preferred treatment option for VGPN with evident neurovascular insult.
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Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Michael Spadola
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Michael McAree
- Department of Neurosurgery, Rowan School of Osteopathic Medicine, Philadelphia, USA
| | - Svetlana Kvint
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
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Whitman MA, Jefferson A, Pincelli T, Sanghavi DK. Case of vago-glossopharyngeal neuralgia secondary to metastatic oropharyngeal cancer. BMJ Case Rep 2020; 13:13/6/e232820. [PMID: 32595127 DOI: 10.1136/bcr-2019-232820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Glossopharyngeal neuralgia (GN) is a rare pain syndrome caused by compression of the glossopharyngeal nerve. It is typically idiopathic and often goes misdiagnosed because of its similarities to trigeminal neuralgia. Vago-glossopharyngeal neuralgia, an even rarer subset of GN, occurs when the pain is accompanied by syncope and/or arrhythmia. Here, we present the case of a 54-year-old man with oropharyngeal cancer that metastasised to areas within his left carotid sheath. He presented with numerous intermittent episodes of pain, accompanied by vagal episodes. While this presentation is similarly described in prior case reports, our case is unique in that the syndrome occurred as a direct sequelae of a metastatic tumour completely encasing the left internal carotid artery.
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Affiliation(s)
| | | | | | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Banerjee C, Viers A, Vender J. Glossopharyngeal Neuralgia/Neuropathy with Hemodynamic Instability and Associated Syncope Treated with Stereotactic Radiosurgery. World Neurosurg 2020; 139:314-317. [PMID: 32344136 DOI: 10.1016/j.wneu.2020.04.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Glossopharyngeal neuralgia/neuropathy is rare, and less than 3% of cases involve cardiac arrhythmias of syncope due to activated vagal reflex pathways. Most of these cases are successfully treated with medical management with or without pacemaker placement. We present the first reported case of glossopharyngeal neuralgia/neuropathy with cardiac symptoms refractory to medical management including pacemaker placement but successfully treated with Gamma Knife Radiosurgery. CASE DESCRIPTION A 70-year-old Caucasian man with recurrent squamous cell carcinoma of the tongue base treated with multiple surgeries, lymph node excision, chemotherapy, and external beam radiation, developed episodes of severe right ear and throat pain. These episodes would be followed by syncopal episodes associated with hypotension and bradycardia. Aggressive medical management including pacemaker could not stabilize the patient's hemodynamic instability. After extensive workup, the patient was diagnosed with glossopharyngeal neuralgia/neuropathy with associated carotid sinus instability. The patient was not a strong surgical candidate, thus the patient underwent Gamma Knife Radiosurgery. The target was set as the glossopharyngeal meatus. Within days of treatment, the patient had no further clinically significant syncope or hemodynamic instability for the remaining 6 months of his life. CONCLUSIONS To our knowledge, we present the first case of glossopharyngeal neuralgia/neuropathy with medically refractory cardiac dysfunction successfully treated with Gamma Knife Radiosurgery. We advocate that Gamma Knife be considered for similar subsets of patients.
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Affiliation(s)
- Christopher Banerjee
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
| | - Angela Viers
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John Vender
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Nagata K, Tajiri K, Ueda A, Okuda Y, Tokimitsu Y, Shinagawa K, Entani A, Okada K, Kaku B, Yasuda I. Glossopharyngeal Neuralgia with Syncope Caused by Recurrence of Esophageal Squamous Cell Carcinoma. Intern Med 2019; 58:933-936. [PMID: 30568145 PMCID: PMC6478984 DOI: 10.2169/internalmedicine.1838-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We herein report a case of glossopharyngeal neuralgia with repeated syncope caused by the recurrence of esophageal carcinoma. The typical symptoms of glossopharyngeal neuralgia are paroxysmal, stabbing, electric shock-like pain in the pharynx and/or base of the tongue on swallowing and talking. In addition, syncope can also be caused by glossopharyngeal neuralgia. The diagnosis of glossopharyngeal neuralgia is not always easy because of its rarity. In the present case, we suspected that repeated syncope was caused by glossopharyngeal neuralgia due to the recurrence of esophageal carcinoma. Concurrent chemoradiation therapy was effective in reducing the tumor size, which resulted in the complete resolution of the symptoms.
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Affiliation(s)
- Kohei Nagata
- Third Department of Internal Medicine, Toyama University Hospital, Japan
- Toyama Red Cross Hospital, Japan
| | - Kazuto Tajiri
- Third Department of Internal Medicine, Toyama University Hospital, Japan
| | | | | | | | | | | | | | | | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Japan
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Burfield L, Ahmad F, Adams J. Glossopharyngeal neuralgia associated with cardiac syncope. BMJ Case Rep 2016; 2016:bcr-2015-214104. [PMID: 27102416 DOI: 10.1136/bcr-2015-214104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glossopharyngeal neuralgia is a rare pain syndrome presenting with paroxysms of pain in the region of the glossopharyngeal nerve. Even more uncommon is the association between glossopharyngeal neuralgia and cardiac syncope. In these patients, the cardiovascular consequences may include bradycardia, hypotension and cardiac arrest. We describe the case of a 40-year-old patient who presented with this rare association of glossopharyngeal neuralgia and syncope. Multiple pauses including one lasting 14 s were noted on ambulatory ECG monitoring. In this case, the patient declined pharmacological treatment with carbamazepine or with permanent pacing and so far has been in remission from symptoms for 3 months.
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Affiliation(s)
| | - Faheem Ahmad
- Queen Elizabeth University Hospital, Glasgow, UK
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Krasoudakis A, Anyfantakis D, Hadjipetrou A, Kastanakis M, Symvoulakis EK, Marathianos S. Glossopharyngeal neuralgia associated with cardiac syncope: Two case reports and literature review. Int J Surg Case Rep 2015; 12:4-6. [PMID: 25974354 PMCID: PMC4485693 DOI: 10.1016/j.ijscr.2015.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Vago-glossopharyngeal neuralgia is an unusual clinical syndrome characterized by paroxysms of sharp pain in the distribution of glossopharyngeal nerve. Rarely the condition is associated with arrhythmia and cardiac syncope, a phenomenon named vagoglossopharyngeal neuralgia. PRESENTATION OF CASES Here we present two patients with glosopharyngeal neuralgia associated with repetitive episodes of syncope referred from their primary care physician to neurosurgery department of a general hospital in Crete, Greece. The patients were successfully treated with microvascular decompression. DISCUSSION A literature review on pathogenesis, diagnosis and management is also performed. CONCLUSIONS Surgeons as well as primary care physicians have to be aware of this rare condition in order to prevent associated life-threatening complications and improve patient's clinical status with accurate therapy.
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Affiliation(s)
- Antonios Krasoudakis
- Department of Neurosurgery, Saint George General Hospital of Chania, Crete, Greece
| | | | | | - Miltiades Kastanakis
- First Department of Surgery, Saint George General Hospital of Chania, Crete, Greece
| | | | - Stavros Marathianos
- Department of Neurosurgery, Saint George General Hospital of Chania, Crete, Greece
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Kim SH, Han KR, Kim DW, Lee JW, Park KB, Lee JY, Kim C. Severe pain attack associated with neurocardiogenic syncope induced by glossopharyngeal neuralgia: successful treatment with carbamazepine and a permanent pacemaker -a case report-. Korean J Pain 2010; 23:215-8. [PMID: 20830270 PMCID: PMC2935986 DOI: 10.3344/kjp.2010.23.3.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 07/23/2010] [Accepted: 07/23/2010] [Indexed: 11/05/2022] Open
Abstract
Glossopharyneal neuralgia (GPN) is generally considered to be a pain disease. However, it can be also be a life-threatening cardiac cause of syncope. Neuralgia in the throat and neck can trigger severe bradycardia up to the point of asystole, which can progress to cardiac syncope with or without seizures. A 65 year-old male patient diagnosed with glossopharyngeal neuralgia complained of severe paroxysmal pain in his right chin and ear followed by bradycardia, aystole and syncope. We report a case successfully treated with a permanent pacemaker and carbamazepine in a patient with GPN who had syncopal attacks preceded by paroxysms of pain.
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Affiliation(s)
- Seung Ho Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea
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Jugular foramen schwannoma presenting with glossopharyngeal neuralgia syncope syndrome. The Journal of Laryngology & Otology 2010; 124:1305-8. [PMID: 20602849 DOI: 10.1017/s0022215110001556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Jugular foramen schwannomas are rare skull base tumours which typically have a variable clinical presentation. Glossopharyngeal syncope syndrome is an unusual clinical presentation; in the following case report, it was the sole presentation of an extracranial jugular foramen tumour. METHODS The presentation of a patient with glossopharyngeal neuralgia syncope syndrome is reviewed and the pathophysiology, clinical features and treatment discussed. RESULTS A 45-year-old woman presented with unilateral throat pain, bradycardia and hypotension leading to episodes of impaired consciousness when lying on her left side or turning her head to the left. Imaging detected a left-sided extracranial jugular foramen schwannoma. The tumour was excised, and the patient had no more syncopal attacks. CONCLUSION Glossopharyngeal neuralgia syncope syndrome can be the sole presentation of a jugular foramen schwannoma. Although this syndrome may be treated with anti-dysrhythmic drugs, cardiac pacing or nerve section, in the presented patient excision of the jugular foramen schwannoma was successful in preventing further episodes of syncope.
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Ju JH, Kang MH, Kim HG, Lee GW, Park JJ, Kim JP, Kang JH. Successful treatment of syncope with chemotherapy irresponsive to cardiac pacemaker in head and neck cancer. Yonsei Med J 2009; 50:725-8. [PMID: 19881981 PMCID: PMC2768252 DOI: 10.3349/ymj.2009.50.5.725] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 03/02/2008] [Accepted: 03/02/2008] [Indexed: 11/27/2022] Open
Abstract
Recurrent syncope as a complication of recurrent neck malignancy is an uncommon but well documented association. The syncope is presumed to occur when a tumor mass invades the baroreceptor within the carotid sinus or when it disrupts the afferent nerve fibers of the glossopharyngeal nerve. A 59-year-old man presented with recurrent syncope and headache. He had a wide local excision including tonsillectomy and modified left radical neck dissection for tonsilar cancer 4 years ago. A computed tomography scan revealed ill-defined lesions in left parapharyngeal, carotid space and right upper jugular region. After clinical evaluation, cardiac pacemaker was placed, but he still suffered from the syncope. Then, he received the chemotherapy with docetaxel and cisplatin. The last hypotension event occurred on day 10 of the chemotherapy. Six months after 3 cycles of chemotherapy, he remained in complete remission and resolution of syncope. We report a case in which syncope was associated with a recurrence of tonsilar cancer and successfully treated with chemotherapy.
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Affiliation(s)
- Ji Hyun Ju
- Department of Internal Medicine, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Myoung Hee Kang
- Department of Internal Medicine, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Hoon Gu Kim
- Department of Internal Medicine, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
- Gyeongnam Regional Cencer Center, Jinju, Korea
| | - Gyeong Won Lee
- Department of Internal Medicine, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
- Gyeongnam Regional Cencer Center, Jinju, Korea
| | - Jung Je Park
- Department of Otolaryngology, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
- Gyeongnam Regional Cencer Center, Jinju, Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
- Gyeongnam Regional Cencer Center, Jinju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Post-Graduate Medical School, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Science, Jinju, Korea
- Gyeongnam Regional Cencer Center, Jinju, Korea
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Esaki T, Osada H, Nakao Y, Yamamoto T, Maeda M, Miyazaki T, Sumiyoshi M, Mori K. Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports. Br J Neurosurg 2009; 21:599-602. [PMID: 18071988 DOI: 10.1080/02688690701627138] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
We describe a case of a patient with glossopharyngeal neuralgia (refractory to treatment with carbamazepine, amytriptyline, diazepam, and indomethacin) treated with lamotrigine as monotherapy, the first described, who responded completely to the therapy and did not complain of side effects. The complete analgesic effect was reached at the lamotrigine daily dose of 200 mg per day and was maintained at that dose for additional 6 months, with the blood concentration within the reference range.
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Ozenci M, Karaoguz R, Conkbayir C, Altin T, Kanpolat Y. Glossopharyngeal neuralgia with cardiac syncope treated by glossopharyngeal rhizotomy and microvascular decompression. Europace 2003; 5:149-52. [PMID: 12633639 DOI: 10.1053/eupc.2002.0298] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A glossopharyngeal neuralgia case with cardiac asystole is presented. The sinus mode dysfunction and subsequent syncope with pain appears to be the most important life-threatening symptom in the late period of the disease. Because of cardiac symptoms induced by intense vagal stimulation, this case was considered to be vagoglossopharyngeal neuralgia. Several medical and surgical alternatives have been proposed for its treatment. In the presented case the cause of disease was compression of lower cranial nerves in the right cerebello-pontine angle (CPA) by the vertebro-basilar arterial system. Carbamazepine and pacing were determined ineffective, so the patient was treated surgically by cutting the glossopharyngeal nerve and by decompression of the vagal nerve at the CPA. The sinus arrest and paroxysmal pain attacks disappeared and the patient's life returned to normal.
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Affiliation(s)
- M Ozenci
- Department of Cardiology, School of Medicine, University of Ankara, Ankara, Turkey.
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Ferrante L, Artico M, Nardacci B, Fraioli B, Cosentino F, Fortuna A. Glossopharyngeal neuralgia with cardiac syncope. Neurosurgery 1995; 36:58-63; discussion 63. [PMID: 7708169 DOI: 10.1227/00006123-199501000-00007] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Glossopharyngeal Neuralgia is an uncommon craniofacial pain syndrome that is occasionally associated with cardiac syncope. Involvement of the glossopharyngeal nerve may be painless or may be marked by true episodic neuralgia, and this justifies the term neuralgia reported here. We present 5 cases of this uncommon syndrome, of a total of 15 observed cases of glossopharyngeal neuralgia, successfully treated by section of the rootlets of Cranial Nerves IX and X or by microvascular decompression in the posterior cranial fossa. We also analyze the relevant literature and discuss the pathogenesis and treatment of the syndrome.
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Affiliation(s)
- L Ferrante
- Department of Neurological Sciences, Neurosurgery, University of Rome La Sapienza, Italy
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