Glossopharyngeal neuralgia associated with cardiac syncope

Burfield, Laura; Ahmad, Faheem; Adams, Jacqueline

doi:10.1136/bcr-2015-214104

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…Only three patients in this group had symptoms of episodic arrhythmias such as bradycardia but had no serious events such as syncope. In fact, severe syncope symptoms have been rarely reported internationally; Burfield et al ( 20 ) and Aguiar et al ( 21 ) have reported relevant cases.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of MVD and RHZ in the treatment of primary glossopharyngeal neuralgia: A clinical report on 61 cases

Wang

Liu²,

Xiao³

et al. 2023

Front. Neurol.

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ObjectiveClinical data on 61 patients (grouped by their treatment with MVD or RHZ) with glossopharyngeal neuralgia were analyzed retrospectively. A summary analysis of the effective rate and surgical complications of MVD and RHZ in the treatment of glossopharyngeal neuralgia was performed to observe the new surgical options for GN.MethodFrom March 2013 to March 2020, 63 patients with GN were admitted to our hospital by the professional group of cranial nerve diseases. Two patients diagnosed with tongue and pharynx pain secondary to tongue cancer and upper esophageal cancer, respectively were excluded from the group. The remaining patients all met the diagnosis of GN, some of them were treated with MVD and others were treated with RHZ. The pain relief rate, long-term results, and complications of the patients in the two groups were well-organized and analyzed.ResultOf the 61 patients, 39 were treated with MVD and 22 were treated with RHZ. In the early-stage patients (the first 23 patients), all of them were operated on with the MVD procedure except one patient without vascular compression. In the later-stage patients, MVD was performed for evident single arterial compression according to the intraoperative situation. And for compression of arteries with greater tension or PICA + VA complex compression, RHZ was performed. It was also performed in cases where vessels with tight adhesions to the arachnoid and nerves could not be easily separated, or where it was easy to damage the perforating arteries after separating the blood vessels, causing vasospasm, which affects the blood supply to the brainstem and cerebellum. RHZ was also performed if there was no clear vascular compression. The efficiency of both groups was 100%. In the MVD group, one case recurred 4 years after the initial operation, and RHZ was performed for reoperation. Complications related to the operation included one case of swallowing and coughing in the MVD group, and three cases in the RHZ group; two cases of uvula not centering in the MVD group, and five cases in the RHZ group. There was 2 patients in RHZ group lost taste in 2/3 of the backing of the tongue, though these symptoms mostly disappeared or decreased after follow-up. One patient in the RHZ group had developed tachycardia by the time of the long-term follow-up, but whether it was related to the surgery is still uncertain. In terms of serious complications, there were two cases of postoperative bleeding in the MVD group. Based on the clinical characteristics of the patients' bleeding, it was judged that the cause of the bleeding was ischemia and was related to an intraoperative injury to the penetrating artery of the PICA artery and vasospasm.ConclusionMVD and RHZ are effective methods for the treatment of primary glossopharyngeal neuralgia. MVD is recommended for cases where vascular compression is clear and easy to handle. However, for cases with complex vascular compression, tight vascular adhesions, difficult separation, and without clear vascular compression, RHZ could be performed. Its efficiency is equivalent to MVD, and there is no significant increase in complications such as cranial nerve disorders. There are few cranial nerve complications that seriously affect the quality of life of patients. RHZ helps to reduce the risk of ischemia and bleeding during surgery by reducing the risk of arterial spasms and injury to the penetrating arteries by separating the vessels due to separation of vessels during MVD. At the same time, it may reduce the postoperative recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of MVD and RHZ in the treatment of primary glossopharyngeal neuralgia: A clinical report on 61 cases

Wang

Liu²,

Xiao³

et al. 2023

Front. Neurol.

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“…Although there was no declared glossopharyngeal-vagal reflex, the occurrence of vagal syncope during glossopharyngeal neuralgia indicates that there should be a relationship between the glossopharyngeal and vagus nerves. [10] Most proposed mechanisms are based on the close anatomical relationship between the glossopharyngeal and vagus nerves in the medulla oblongata and the possibility of vagoglossopharyngeal reflex arc formation. [11] Another view suggests that some visceral sensory fibers of the glossopharyngeal nerve might connect with fibers of the carotid sinus nerve (nerve of Hering), stimulating the latter; therefore, activation of the baroreceptors of the carotid sinus, resulting in bradycardia, asystole, premature atrial contractions, or hypotension that can lead to syncope.…”

Section: Discussionmentioning

confidence: 99%

Transient asystole during balloon dilation of the Eustachian tube: A case report

et al. 2022

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Rationale: Neurally mediated reflexes can induce cardiac arrest during head and neck surgery through mechanisms including direct vagal stimulation, trigeminocardiac reflex, and baroreceptor reflex. Balloon dilation of the Eustachian tube (BDET) is a safe procedure without serious complications, including cardiac arrest.Patient concerns: Transient asystole developed during BDET under general anesthesia in a 33-year-old woman as soon as the balloon in the Eustachian tube (ET) was inflated.Diagnoses: Monitoring records were reviewed. The asystolic period was recorded on the patient monitor as an event, which we recalled and printed. The asystole lasted for 13 seconds.Interventions: The patient recovered sinus rhythm spontaneously after the balloon was deflated before resuscitation. The BDET was successfully performed after prophylaxis with vagolytic drugs.Outcomes: The patient recovered uneventfully after anesthesia.Lessons: BDET, previously known to be a relatively safe procedure, induces asystole via balloon dilation. It is thought to be a neurally mediated vagal reflex, and both anesthesiologists and otologic physicians should pay proper attention to monitoring during the procedure.Abbreviations: BDET = balloon dilation of the Eustachian tube, ETD = Eustachian tube dysfunction.

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“…One hypothesis is that vascular compression of the IXth nerve causes the neuralgia, and a simultaneous compression of the Xth nerve triggers a direct parasympathetic outflow to the heart [ 13 ]. The other hypothesis is that the compression of the IXth nerve causes the neuralgia but also triggers impulses from what would be Hering's nerve to travel up to the brainstem (to the nucleus tractus solitarius) which then senses a false hypertension and triggers a reflexive bradycardia down the vagus nerve [ 14 , 15 ]. Our results support the second hypothesis for two reasons.…”

Section: Discussionmentioning

confidence: 99%

The Location of the Parasympathetic Fibres within the Vagus Nerve Rootlets: A Case Report and a Review of the Literature

Al-Kubaisi

Dong

Honey

2022

Stereotact Funct Neurosurg

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The vagus nerve has motor, sensory, and parasympathetic components. Understanding the nerve’s internal anatomy, its variations, and relationship to the glossopharyngeal nerve are crucial for neurosurgeons decompressing the lower cranial nerves. We present a case report demonstrating the location of the parasympathetic fibres within the vagus nerve rootlets. A 47-year-old woman presented with a 1-year history of medically refractory left-sided glossopharyngeal neuralgia and a more recent history of left-sided hemi-laryngopharyngeal spasm. magnetic resonance imaging showed her left posterior inferior cerebellar artery distorting the lower cranial nerves on the affected left side. The patient consented to microvascular decompression of the lower cranial nerves with possible sectioning of the glossopharyngeal and upper sensory rootlets of the vagus nerve. During surgery, electrical stimulation of the most caudal rootlet of the vagus nerve triggered profound bradycardia. None of the more rostral rootlets had a similar parasympathetic response. This case is the first demonstration, to our knowledge, of the location of the cardiac parasympathetic fibres within the human vagus nerve rootlets. This new understanding of the vagus nerve rootlets’ distribution of pure sensory (most rostral), motor/sensory (more caudal), and parasympathetic (most caudal) fibres may lead to a better understanding and diagnosis of the vagal rhizopathies. Approximately 20% of patients with glossopharyngeal neuralgia also have paroxysmal cough. This could be due to the anatomical juxtaposition of the IXth cranial nerve with the rostral vagal rootlets with pure sensory fibres (which mediate a tickling sensation in the lungs). A subgroup of patients with glossopharyngeal neuralgia have neuralgia-induced syncope. The cause of this rare condition, “vago-glossopharyngeal neuralgia,” has been debated since it was first described by Riley in 1942. Our case supports the theory that this neuralgia-induced bradycardia is reflexively mediated through the brainstem with afferent impulses in the IXth and efferent impulses in the Xth cranial nerve. The rarer co-occurrence of glossopharyngeal neuralgia with hemi-laryngopharyngeal spasm (as seen in this case) may be explained by the proximity of the IXth nerve with the more caudal vagus rootlets which have motor (and probably sensory) supply to the throat. Finally, if there is a vagal rhizopathy related to compression of its parasympathetic fibres, one would expect it to be at the most caudal rootlet of the vagus nerve.

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Glossopharyngeal neuralgia associated with cardiac syncope

Cited by 10 publications

References 24 publications

Comparative analysis of MVD and RHZ in the treatment of primary glossopharyngeal neuralgia: A clinical report on 61 cases

Comparative analysis of MVD and RHZ in the treatment of primary glossopharyngeal neuralgia: A clinical report on 61 cases

Transient asystole during balloon dilation of the Eustachian tube: A case report

The Location of the Parasympathetic Fibres within the Vagus Nerve Rootlets: A Case Report and a Review of the Literature

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