Glossopharyngeal neuralgia associated with cardiac syncope and weight loss

Glossopharyngeal neuralgia is an uncommon condition that has rarely been described in association with syncope and never with significant weight loss. A 50-year-old previously healthy woman presented with a 3-month history of episodic brief attacks of pain in the left side of her throat that were precipitated by swallowing. The spells gradually became more severe and progressed to loss of consciousness several times a day. Because of the severe pain and the recurrent episodes of syncope, the patient refused to eat and drink almost everything and thus she lost 6 kg in 2 weeks. During a typical episode of attacks, electrocardiographic monitoring demonstrated severe bradycardia and asystole for 4 second. Carbamazepine therapy (600 mg/d) completely abolished the pharyngeal pain and the associated cardiac manifestations for at least 12 months, thereby enabling rapid restoration of the lost weight.