Glossopharyngeal Neuralgia with Syncope Caused by Neurovascular Compression and Demonstration by High-Resolution MR Imaging: A Case Report

Abstract

Glossopharyngeal neuralgia (GPN) is a rare condition with a reported incidence of 0.7/100000/year (1). It is characterized by paroxysms of lancinating pain localized unilaterally in the base of the tongue, soft palate, throat, and in the lateral and posterior regions of the pharynx, radiating to the ipsilateral ear. The pain can be triggered by swallowing, coughing, yawning, and chewing, and it usually lasts only for seconds (2). Occasionally, GPN can be associated with cardiac syncope, which is caused by asystole or bradycardia in most cases, and possibly by a vasodepressor reaction as well (2, 3). This syndrome may be referred to as vagoglossopharyngeal neuralgia when the cardiac symptoms accompany pain attacks (3). The causes of GPN are diverse and are divided in the two groups. Idiopathic type of GPN is attributed to the compression of cisternal part of glossopharyngeal nerve by intracranial vessels (4). Secondary type is associated with various lesions that affect the glossopharyngeal nerve at different levels of its path at brainstem structures, cisternal branches, and extracranial divisions (5). Here, we present a case of GPN with recurrent syncope by neurovascular compression.