Case Report: Radiofrequency Pulsed Therapy for Glossopharyngeal Neuralgia with Associated Syncope

Abstract

Glossopharyngeal neuralgia (GPN) is characterized by paroxysmal, severe, and lancinating pain at the base of the tongue and throat on one side, often radiating to the oropharynx or ear. The intensity of the pain can be debilitating and, in severe cases, may be accompanied by potentially life-threatening conditions such as cardiac arrhythmias and syncope, significantly impacting the patient's quality of life. The incidence of GPN is low, and there is limited clinical awareness and understanding of the condition, leading to a high rate of misdiagnosis. In recent years, pulsed radiofrequency has emerged as an effective and minimally invasive treatment modality for the management of GPN. We report a case of a 56-year-old male patient with recurrent glossopharyngeal neuralgia accompanied by syncope. The patient tested positive for the topical application of local anesthetics, and cranial nerve magnetic resonance imaging (MRI) revealed compression of the right glossopharyngeal nerve by a small blood vessel. Both 24-hour Holter monitoring and video electroencephalography (EEG) showed no abnormalities. In addition to treatment with carbamazepine and pregabalin, the patient's pain as well as syncope resolved after two sessions of CT (ComputedTomography)-guided pulsed radiofrequency (PRF) therapy of the glossopharyngeal nerve. Clinicians should be aware of the rare clinical occurrence of glossopharyngeal neuralgia with syncope. PRF is a measure of safe and effective which could be considered the first choice for minimally invasive therapy.