J Korean Soc Radiol.  2014 Sep;71(3):107-110. 10.3348/jksr.2014.71.3.107.

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

• Lee S
• Baek HJ

• KMID: 1736474
• DOI: http://doi.org/10.3348/jksr.2014.71.3.107

Abstract

Glossopharyngeal neuralgia with syncope is a rare syndrome. It is characterized by paroxysms of neuralgic pain in the throat and pharynx, and is associated with transient loss of consciousness caused by brief periods of cardiac arrhythmia. Glossopharyngeal neuralgia is caused by neoplasm, infection, vascular malformation, or neurovascular compression. Herein, we present a rare case of glossopharyngeal neuralgia with syncope, which was caused by an extrinsic compression of lower cranial nerves in the right cerebellomedullary cistern by the ipsilateral posterior inferior cerebellar artery. In this case, high-resolution MR imaging played a key role in the diagnosis of neurovascular compression induced glossopharyngeal neuralgia.

MeSH Terms

Arrhythmias, Cardiac
Arteries
Cranial Nerves
Diagnosis
Glossopharyngeal Nerve Diseases*
Magnetic Resonance Imaging*
Pharynx
Syncope*
Unconsciousness
Vascular Malformations

Figure

• 

  Fig. 1 A 62-year-old woman with paroxysmal pain attacks originating from the right lower jaw. A-C. Axial 3D T2 VISTA images reveal the root-entry zone of the right glossopharyngeal and vagus nerves (white arrows) in contact with vascular loop of the right posterior inferior cerebellar artery (PICA) (black arrows) in the right cerebellopontomedullary angle, resulting posterior displacement of nerve complex. Normal left glossopharyngeal and vagus nerves (arrowheads) is seen, and no vessel is in contact with these nerves at this location. D. 3D TOF MR angiography demonstrates the right PICA which arises from the vertebral artery and forms tortuous vascular looping (arrow). E-G. 3D FLAIR VISTA images depict posterior displacement of the right glossopharyngeal and vagus nerves (arrows). On the left side, normal glossopharyngeal and vagus nerves is also seen (arrowheads).

Reference

1. Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci. 2005; 26:Suppl 2. s65–s67.

2. Johnston RT, Redding VJ. Glossopharyngeal neuralgia associated with cardiac syncope: long term treatment with permanent pacing and carbamazepine. Br Heart J. 1990; 64:403–405.

3. Kanpolat Y, Savas A, Batay F, Sinav A. Computed tomography-guided trigeminal tractotomy-nucleotomy in the management of vagoglossopharyngeal and geniculate neuralgias. Neurosurgery. 1998; 43:484–489. discussion 490.

4. Kandan SR, Khan S, Jeyaretna DS, Lhatoo S, Patel NK, Coakham HB. Neuralgia of the glossopharyngeal and vagal nerves: long-term outcome following surgical treatment and literature review. Br J Neurosurg. 2010; 24:441–446.

5. Singh PM, Kaur M, Trikha A. An uncommonly common: glossopharyngeal neuralgia. Ann Indian Acad Neurol. 2013; 16:1–8.

6. Gaitour E, Nick ST, Roberts C, Gonzalez-Toledo E, Munjampalli S, Minagar A, et al. Glossopharyngeal neuralgia secondary to vascular compression in a patient with multiple sclerosis: a case report. J Med Case Rep. 2012; 6:213.

7. Ferrante L, Artico M, Nardacci B, Fraioli B, Cosentino F, Fortuna A. Glossopharyngeal neuralgia with cardiac syncope. Neurosurgery. 1995; 36:58–63. discussion 63.

8. Elias J, Kuniyoshi R, Carloni WV, Borges MR, Peixoto CA, Pimentel D. Glossopharyngeal neuralgia associated with cardiac syncope. Arq Bras Cardiol. 2002; 78:510–519.

9. Boch AL, Oppenheim C, Biondi A, Marsault C, Philippon J. Glossopharyngeal neuralgia associated with a vascular loop demonstrated by magnetic resonance imaging. Acta Neurochir (Wien). 1998; 140:813–818.

10. Hiwatashi A, Matsushima T, Yoshiura T, Tanaka A, Noguchi T, Togao O, et al. MRI of glossopharyngeal neuralgia caused by neurovascular compression. AJR Am J Roentgenol. 2008; 191:578–581.