Successful implanted pacemaker for an extreme inhibitory reflex syncope evoked by post herpetic trigeminal neuralgia

Abstract

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Numerous causes of syncope have been described. Vasovagal syncope is the most common with a number of precipitants. We report a case of post herpetic trigeminal neuralgia leading to neurocardiogenic syncope. These episodes were preceded by severe stabbing left frontal headaches followed by significant sinus bradycardia, asystole, and syncope requiring pacemaker implantation. To our knowledge only one previous case of post herpetic trigeminal neuralgia leading to syncope has been reported. <Learning objective: Neuralgia-associated syncope is a rare phenomenon. Failing to recognize and treat appropriately may be associated with recurring episodes of syncope with significant lifestyle limitations. Although post herpetic neuralgia is treatable, one should be prepared to insert a pacemaker if treatment fails to control symptoms that progress to cardioinhibitory syncope.>