Glossopharyngeal Neuralgia Accompanied by Unconsciousness

The purpose of this presentation is to discuss the diagnostic criteria of glossopharyngeal neuralgia and to emphasize the role of the syndrome that resembles that of the carotid sinus reflex, as seen in an occasional case. The syndrome of glossopharyngeal neuralgia was first described by Weisenburg 1~ in 1910 in a case of angle tumor pressing on the 9th cranial nerve. Ten years later Sicard and Robineau s reported 3 cases of glossopharyngeal neuralgia. During the following 7 years until 1927, 2 cases had been reported by Harris, 3 9 from the Mayo Clinic, and 2 by Dandy? Adson ~ in 1924 presented a technique for peripheral nerve section in the neck for this nerve. He said that it was a difficult surgical procedure because of the anatomica] position of the nerve. At the time he had explored the possibility of cutting the nerve intracranially, by cadaver dissection, illustrating the unilateral cerebellar approach. However in 1927 Dandy reported the first intracranial section of the nerve, when he operated upon 2 patients within 6 weeks' time through a unilateral cerebellar craniectomy wound. Since then there have been many case reports illustrating the diagnostic and operative features of the disease. Glossopharyngeal neuralgia differs from trigeminal neuralgia (tic douloureux) only in the location of the pain. Both have characteristic locations of the sudden, severe, paroxysmal, lightning-like pain, frequently set off by external stimuli. Each generally occurs in middle to late life. It remains only to distinguish the location of the pain by taking a careful history to establish the correct diagnosis. However, occasionally the patient is unable to give an exact account of the pain either because of its severity or because of mental deficits, such as senility, low mentality, etc. As we all know, this pain is located in the glossopharyngeal region, back of the tongue or in the ear. Confusion in diagnosis should occur only when the most severe pain is located in front of the ear or seemingly within it. Then the differential diagnosis of neuralgia of the nervus intermedius (nerve of Wrisberg), or 3rd division tic must be made. Cocainization of the throat usually, but not always, abolishes the pain for some minutes and thus aids the diagnosis. Intracranial section of the 9th nerve alone generally relieves the pain entirely but if the ear pain is especially bad, section of the upper two filaments of the vagus should be done, which has been stressed by both Dandy and Spurling2 The resultant anesthesia is confined to the pharynx, nasopharynx, back of the tongue and tonsillar pillars. No motor deficit has been shown resulting from the paralyzed stylopharyngeus muscle. A much less frequent involvement in the disease process is the resemblance to the syndrome of the hyperirritable carotid sinus. The carotid sinus receives its nerve supply from branches of the glossopharyngeal (nerve of tiering--an afferent branch), * Read at the annual meeting of the Southern Neurosurgical Society, Baltimore, Maryland, January