| Abstract: | ABSTRACT: Glossopharyngeal neuralgia is an uncommon, painful syndrome, characterized by paroxysmsof pain in the sensory distribution of the 9th cranial nerve. Idiopathic glossopharyngealneuralgia may be due to compression of the glossopharyngeal nerve by adjacent vessels,while secondary glossopharyngeal neuralgia is associated with identifiable lesions affectingthe glossopharyngeal nerve at different levels of its neuroanatomic pathway.Glossopharyngeal neuralgia is rare in the general population, but is more common in patientswith multiple sclerosis. CASE PRESENTATION: A 56-year-old Caucasian woman with multiple sclerosis and migraine presented to ourfacility with intermittent lancinating pain to the right of her throat, tongue, and the floor ofher mouth that had been occurring for the past year. The pain was intense, sharp, andstabbing, which lasted two to six seconds with radiation to the right ear. Initially, the attackswere infrequent, however, they had become more intense and frequent over time. Our patientreported weight loss, headache, painful swallowing, and the inability to maintain sleep due topainful attacks. A neurological examination revealed a right-handed woman with triggerpoints in the back of the tongue and throat on the right side. She also had dysphagia,hoarseness, and pain in the distribution of the right glossopharyngeal nerve. Mild righthemiparesis, hyperreflexia, dysmetria, and an ataxic gait were present. A magnetic resonanceimaging scan of the brain was consistent with multiple sclerosis and magnetic resonanceangiography demonstrated a loop of the posterior inferior cerebellar artery compressing theright glossopharyngeal nerve. She responded satisfactorily to carbamazepine. Microvasculardecompression and Gamma Knife? radiosurgery were discussed in case of failure of themedical treatment; however, she declined these options. CONCLUSIONS: Glossopharyngeal neuralgia in multiple sclerosis may occur due to vascular compressivelesions and it should not be solely attributed to the underlying demyelinating process.Vascular compression of the glossopharyngeal nerve could independently causeglossopharyngeal neuralgia in patients with multiple sclerosis, and vascular imaging toexclude such a diagnosis is recommended. |
