[Glossopharyngeal neuralgia and syncope]

The causes of neuralgia are usually not known, but the condition can be caused by an underlying condition.

A 58-year-old man presented at the accident and emergency department with a 6-week history of continuous nagging pain in the region of his right ear, extending to the lower jaw and the right side of his neck; this worsened in progressive attacks, which were sometimes followed by non-rotatory dizziness and loss of consciousness. This clinical picture lead us to suspect glossopharyngeal neuralgia (GPN) because of the distribution of the pain and the secondary syncope, but the continuous nature of the pain was atypical and a reason for further investigation. This revealed metastatic parotid gland carcinoma with compression of the right glossopharyngeal nerve. Following palliative radiotherapy, the pain improved and there were no further episodes of loss of consciousness.

When GPN is suspected and there is continuous pain, or neurological investigations reveal abnormalities, an underlying condition should be considered and additional investigations should be carried out.