Atrioventricular Block Associated with Glossopharyngeal Neuralgia

Objective: Glossopharyngeal neuralgia (GPN) is a rare syndrome of facial pain characterized by paroxysms of severe stabbing pain, occurring in the ear, the base of the tongue, the tonsillar fossa, or below the angle of the jaw. GPN can be associated with episodes of bradycardia, severe hypotension, and even cardiac arrest due to a vasodepressor reaction of the vagus nerve. Although GPN is often mistaken for trigeminal neuralgia, its correct diagnosis is important due to potential life-threatening cardiac consequences. We present the case of a patient with atrioventricular block (AV block) associated with GPN.

Case Description: A 79-year-old male patient came to our center after 3-year history of GPN. The electric-shock pain appeared in the region of the left oropharynx and ear with a visual analog scale of 8 and triggered by eating food, speaking and swallowing, which generated weight loss, depressive disorder, as well as asthenia and adynamia. Previously, he was treated by otorhinolaryngologists and maxillofacial surgeons with neuromodulators and NSAIDs without clinical improvement. Within his personal history, the patient mentioned smoking for a period of 20 years and degenerative diseases such as type 1 diabetes mellitus, arterial hypertension and prostatic hyperplasia of 18, 25 and 5 years of evolution, respectively. During the examination, patient referred electrical pain over the carotid triangle; in addition, it was observed symmetrical cylindrical neck without the presence of ganglion chains, oral cavity with adequate hydration, no evidence of jugular venous engorgement, and no presence of thyroid growths.

An MRI with 3D FIESTA sequence was requested, detecting a subjective vascular conflict in the cisternal path of glossopharyngeal nerve. Among the intraoperative studies, an electrocardiogram was included which revealed a grade II AV block ([Fig. 1]).

The patient undergoes suboccipital craniotomy with exploration and decompression of the left glossopharyngeal nerve. Compression of the AICA artery on the glossopharyngeal and vagus nerves was observed and the conflict was solved by interposing a Teflon barrier for both nerves. During the postoperative period, the patient no longer reported pain related to the glossopharyngeal nerve. Finally, a new electrocardiogram study was performed which showed remission of the AV block ([Fig. 2]).

Conclusion: Within the symptoms of GPN, cardiac conditions such as AV block can be detected. Impulses from the glossopharyngeal nerve through the tractus solitarius to the dorsal motor nucleus of the vagal nerves can result in bradycardia or reflected asystole. Microvascular decompression is an effective treatment for GPN and its associated conditions.

Fig. 1 Preoperative electrocardiogram. The red line indicates the presence of a lack of cardiac electrical activity derived from atrioventricular block.

Fig. 2 Postoperative electrocardiogram showing sinus rhythm.

Publication History

Article published online:
15 February 2022