Glossopharyngeal neuralgia, asystole, and seizures occurred in a patient with an internal carotid occlusion and external carotid stenosis. Swallowing was the triggering mechanism for these events. Mechanical stimulation of the pharynx failed to reproduce the symptoms. An ischemic injury to the glossopharyngeal nerve in the region of the jugular foramen that resulted in an artificial synapse is the proposed etiology.
Isolated downbeat nystagmus was observed in 2 patients on multiple anticonvulsant regimens. The nystagmus disappeared when phenytoin dosage was reduced. Electrooculographic analysis revealed impaired downward tracking, supporting the concept of "pursuit" nystagmus.
A 60-year-old man complained of 20-25 second episodes of bilateral arm paralysis. Neuroimaging disclosed spinal cord compression at the C3-4 level caused by a herniated disc and retrolisthesis. Spinal cord ischemia due to impingement of a vertebral artery or its spinal branch was suspected but could not be substantiated by neuroimaging. Discectomy and fusion eliminated these attacks.
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