This study describes our experience in the surgical treatment of neuralgia of the glossopharyngeal and vagal nerves. Over the last 19 years, 21 patients underwent surgery. Their case notes were reviewed to obtain demographic information, clinical presentation, surgical findings and early results. All patients were then contacted by telephone for long-term results and complications. Independent analysis of results was carried out by a Neurology team. Ten patients had microvascular decompression (MVD). Four patients had MVD and nerve section. In the remaining seven patients, the glossopharyngeal and first two rootlets of the vagal nerve were sectioned. Nineteen (90%) of 21 patients experienced complete relief of pain immediately after surgery. The remaining patients reported an improvement in their symptoms. There were no mortalities. Four patients experienced short-term complications, which resolved. Two patients were left with a persistent hoarse voice. At follow-up (mean duration of 4 years), there was no recurrence in symptoms. In our experience, surgery is safe and effective for the treatment of vago-glossopharyngeal neuralgia.
An 85-year-old lady presented to our institution following multiple episodes of transient loss of consciousness. Her admission ECG revealed a junctional bradycardia with significant QT prolongation. Telemetry captured a torsades de pointes arrhythmia. Possible offending drugs (digoxin and hydroxychloroquine) were stopped and she was given intravenous magnesium and potassium. Despite this, she continued to have runs of torsades. An isoprenaline infusion was commenced to increase her resting heart rate. Her QT interval shortened and she had no further arrhythmia. Investigation into the cause of her bradycardia and prolonged QT revealed profound hypothyroidism. Levothyroxine was commenced but the patient remained bradycardia and required a permanent pacemaker. She had no further arrhythmia and was discharged home safely. This is a very rare case of severe primary hypothyroidism presenting with torsades de pointes.
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