[Glossopharyngeal neuralgia with syncope]

Eleven years after treatment of a tonsillar carcinoma by neck dissection, chemotherapy and radiotherapy, a now 26-year-old man had several syncopes, all preceded by burning pain in the area of the left ear with radiation to the throat and left tonsil. ECG monitoring revealed 3 degrees atrioventricular block with a slow idioventricular rhythm (34/min), as well as an asystole lasting 13 seconds. There were renewed syncopes even after pacemaker implantation. 24-hour blood pressure monitoring recorded pressures of 65/50 mm Hg, coinciding with symptoms of pain and dizziness. Being diagnosed as having glossopharyngeal neuralgia with cardiovascular involvement he was given carbamazepine, 400 mg three times daily, but without improvement. Because of this treatment failure the glossopharyngeal nerve was surgically divided, with partial but not complete regression of the symptoms. The patient declined the suggested further bilateral division of the upper vagal branches.