Abstract text (incl. figure legends and references)

Question

Glossopharyngeal neuralgia is a rare facial pain syndrome characterized by painful paroxysms in the sensory distribution of the glossopharingeal nerve. Association with cardiac syncope is even rarer and when it happens it is termed vagoglossopharyngeal neuralgia (VN). We present a case of idiopatic VN with secondary complete atrio-ventricular (AV) block and symptomatic syncopes

Methods

A 66-year-old man with no medical history of interest, presented to Emergency department with high intensity pain in left preauricular region and behind mandibular angle. He described the pain as electrical discharges. These attacks were followed by syncopes of 20-30 seconds duration. Furthermore, during some of these episodes he presented limb shaking without tongue bite or sphincter relaxation.

Cardiac monitoring showed complete AV block followed by sinus bradycardia at 30 beats per minute and subsequent recovery of heart rate.

Between these episodes the patient was asymptomatic. His general and neurological examination was normal.

Results

He was admitted to Intensive Care Unit for monitoring and treatment with aleudrine was started. Chest radiography, echocardiogram, brain magnetic resonance imaging, computed axial tomography of the neck and electroencephalogram were performed with normal results.

Structural heart disease was ruled out. AV-block secondary to increased vagal tone due to NV was diagnosed. Treatment with aleudrine was stopped and carbamazepine was started, after which the patient had no new episodes of neuralgia or cardiac block.

He was discharged and after five months he has kept on treatment and has had no new episodes of neuralgia or syncope.

Conclusions

VN is a rare syndrome. It could be associated with syncopes due to AV-block. Pharmacological therapy is the initial step to the VN treatment, but surgery could be needed in refractory cases. Pacemarker could be required to treat AV-block in selected patients.