Glossopharyngeus-Neuralgie mit Herzrhythmusstörungen

Abstract

In a 68-year-old female patient glossopharyngeal neuralgia of unknown origin occurred accompained by cardiac arrhythmias (bradycardia to asystole) and loss of consciousness. Subcutaneous atropine injections improved bradycardia but did not influence attacks of pain. Complete and permanent freedom from symptoms was established only after treatment with carbamazepine (Tegretal) 200 mg t.d.s.

Glossopharyngeal Neuralgia

“…The effect of atropine clinched the long-surmised ACh-ergic vagal-discharge pathogenesis of the cardiovascular type (60,74,77,79,123,134,136,146,153,155,156,159,162,163). Administration of orciprenalin or of isoproterenol (ß-sympathicomimetic) proved ineffective; so did a pacemaker.…”

“…This type is rare: 42 instances among 304 reported in which the inherent statistical bias toward description of special cases should be taken into account; Rush-ton's series of 217 cases (1) included 4 of the cardiovascular type, whereas Parsons (9) saw 2 instances of cardiac arrest in his series of 15 cases. In 40 anecdotal reports 45 patients have been described (16 female, 26 male) in whom the attacks of pain (17 on the right, 24 on the left side; the youngest patient was , the oldest 76-Torres Ruiz (154); 90% of them were older than 40 years) were associated with either or all of the following symptoms: -Bradycardia, over a time-span of between 10 and 60 sec (59,75,77), during which the pulse-rate may drop to 16 min -1 (48) over even 10 min -1 (83,139), but usually drops some 50% to values ranging between 27 and 45 min -1 (41,60,74,123,136,155,156). Kunc's report (10) is unique in that it has the exclusive distinction of describing a patient with tachycardia (200 min -1 ) during attacks; in St. John's case (157) there was ataxia.…”