Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence

Abstract

-Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.KEY WORDS: glossopharyngeal neuralgia, syncope, neck cancer, recurrence.Neuralgia glossofaríngea com síncope como um sinal de recidiva de câncer do pescoço RESUMO -Neuralgia glossofaríngea com síncope como um sinal de câncer do pescoço é uma condição muito rara. Uma revisão da literatura revelou apenas 29 casos relatados anteriormente. Apresentamos o primeiro caso brasileiro de tal associação. Um homem de 68 anos se apresentou com dores paroxísticas insuportáveis no lado direito do pescoço, algumas vezes seguidas de síncope. Dada a suspeita de recidiva tumoral derivada de uma malignidade cervical tratada previamente, realizou-se um exame de tomografia computadorizada que evidenciou um tumor parafaríngeo direito. As dores e as síncopes foram controladas satisfatoriamente com carbamazepina e o paciente foi submetido à radioterapia paliativa.PALAVRAS-CHAVE: neuralgia glossofaríngea, síncope, câncer do pescoço, recidiva. Dr. According to the second edition of the International Classifi cation of Headache Disorders 1 , glossopharyngeal neuralgia is a brief severe stabbing pain felt in the ear, base of the tongue, tonsillar fossa or beneath the angle of the jaw. Thus, the pain is located in the distributions of the auricular and pharyngeal branches of the vagus nerve plus of the ipsilateral glossopharyngeal nerve. It is commonly incited by swallowing, talking or coughing and may remit and relapse in the manner of trigeminal neuralgia.Glossopharyngeal neuralgia was estimated to be 75 times less frequent than trigeminal neuralgia 2 , and its association with syncope was estimated to occur in 1,84% of the cases 3 . Although generally cryptogenic, this condition sometimes have a demonstrable cause, including neoplasms, infections, infl ammations, trauma, elongated styloid process and vascular compression 2 . Glossopharyngeal neuralgia with syncope as a sign of neck tumor is a very rare condition. A fairly diligent review of the literature revealed only 29 cases formerly reported (Table). We present the fi rst Brazilian case of such association. CASEA 68-year-old white man with a history of paralaryngeal and pyriform sinus lymphoepithelioma was treated with radical surgery and radiotherapy about 2 years ago. His tumor was stage T3 N2b M0 and he underwent bilateral neck dissection, right hemithyroidectomy, pharyngolaryngectomy with later reconstruction by means of a free microvascular right thigh fl ...

A Bone-Breaking Case of Syncope Due to Glossopharyngeal Neuralgia

“…Therapy for GPN-induced syncope varies among reports. In some reports [17,18] treatment with carbamazepine abolished the pain and associated cardiovascular manifestations. However, in other cases, treatment with carbamazepine alone [19,20], carbamazepine and gabapentin combination [21] or clonazepam [22] was not sufficient to alleviate the pain and syncopal episodes in GPN, necessitating the insertion of a permanent pacemaker to prevent syncope.…”

Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

“…Patients with advanced tumoral disease at diagnosis and those with a history of neck surgery appear to be at greater risk of developing syncope [4]. Syncope may be an early sign of neck or cervical cancer [5] and even the sole sign of recurrent disease [6]. Head and neck cancer is the most frequent malignancy associated with syncope.…”