Actualización sobre el síndrome de Eagle y sus complicaciones neurocardiológicas: casos clínicos / An update on Eagle´s syndrome and its neuro-cardiological complications: clinical cases

El síndrome de Eagle o síndrome estilohioideo o sín-drome de la arteria carótida es un trastorno que se origina por la mineralización y elongación del pro-ceso estiloides. Factores traumáticos agudos y cró-nicos, así como otras teorías, han sido propuestos para explicar la etiología y patogenia de esta altera-ción. El conjunto de síntomas puede incluir: dolor fa-ríngeo, odinofagia, disfagia, cefalea, con irradiación a oreja y zona cervical. Si bien existen varias clasifi-caciones, de manera universal se acepta que existen principalmente dos formas de presentación de esta patología: el tipo I o clásico, generalmente asociado a un trauma faríngeo y acompañado de dolor en la zona faríngea y cervical, y el tipo II o carotídeo, que sue-le presentar molestia cervical, cefalea y alteración de la presión arterial, con riesgo de daño de la ac-tividad cardíaca. La identificación de este síndrome suele ser confusa dada la similitud de los síntomas con otras afecciones. El diagnóstico debe realizarse en base a los síntomas y a los estudios por imágenes específicos. El tratamiento puede ser conservador y actuar simplemente sobre los síntomas, o bien, qui-rúrgico. El objetivo del presente trabajo es realizar una revisión actualizada de la literatura sobre el sín-drome de Eagle y presentar tres casos clínicos con distintas manifestaciones (AU)

Eagle's syndrome or styloid syndrome or stylo-carotid artery syndrome is a disease caused by mineralization and elongation of the styloid process. Acute and chronic traumatic factors, along with other hypothesis, have been proposed to explain the aetiology and pathogenesis of this condition. Symptoms can include: pharynx pain, odynophagia, dysphagia, headache, with radiating pain to the ear and neck. Despite there are several classifications, it is universally accepted that this pathology can present in two forms: the type I or classic, generally associated to tonsillar trauma and characterized by pharyngeal and neck pain, and the type II or carotid artery type, which frequently presents with neck pain, headache, blood pressure variation, with risk of damage to cardiac function. Identifying of Eagle's syndrome is often confusing because some symptoms are shared with other pathologies. Diagnosis must be made on the basis of symptoms and imaging studies. Treatment can be conservative, acting only on symptoms, or surgical. The aim of this paper is to provide an updated review of the literature on Eagle syndrome and to present three clinical cases with different manifestations (AU)

Neuralgia del Trigémino, del Glosofaríngeo y Post-herpética en Pacientes del Hospital Universitario San Ignacio (HUSI) Bogota, Colombia

RESUMEN: Determinar las características clínicas, pautas para el diagnóstico, tratamiento y evolución de la neuralgia del trigémino, postherpética y del nervio glosofaríngeo. Se realizó un estudio descriptivo de 119 historias clínicas de pacientes diagnosticados con neuralgia del trigémino, glosofaríngeo y postherpética tratados en el Hospital Universitario San Ignacio, registrando datos de sexo, edad, antecedentes médicos, exámenes complementarios, características clínicas, tratamientos y evolución. Se revisaron 119 historias clínicas, de las cuales 86 pertenecían a mujeres y 33 a hombres, el 84 % correspondían a neuralgias del trigémino, el 11,7 º% a post- herpética, y el 2,5% en el glosofaríngeo. El lado afectado más común fue el lado izquierdo con un 54%, las ramas más afectadas en la neuralgia del trigémino fue la maxilar y mandibular (V2- V3), en la postherpética la oftálmica (V1), la patología concomitante más frecuente hallada en el grupo fue la HTA, el tipo de dolor más frecuente fue el lancinante con un 82,4%. Los medicamentos más utilizados fueron la carbamazepina (60,5%) seguida de pregabalina (29,4%), en tratamientos quirúrgicos la radiofrecuencia fue la más empleada en un 32 %. 30 pacientes presentaron recaídas que en general fueron manejadas con aumento de las dosis de los medicamentos. Este estudio muestra una similitud con la literatura reportada, presentando más casos de neuralgia de trigémino, seguida de la post herpética y por último del glosofaríngeo. Más frecuente en mujeres, con un promedio de edad de 60 años, afectando en mayor proporción la rama mandibular y maxilar en la neuralgia de trigémino y en la postherpética la oftálmica.

ABSTRACT: To determine the clinical characteristics, guidelines for the diagnosis, treatment and evolution of trigeminal neuralgia, postherpetic neuralgia and glossopharyngeal neu- ralgia. A descriptive study of 119 clinical histories of patients diagnosed with Trigeminal Neoplasia, glossopharyngeal and postherpetic treated at the Hospital Universitario San Ignacio, recording data such as: gender, age, medical history, diagnostic exams, clinical features, branches and side of the face affected, treatments and evolution. 86 clinical records of women and 33 of men were evaluated, 100 with trigeminal neuralgia, 14 postherpetic, 3 glossopharyngeal, the most common affected side was the left side with 51%, the most affected branches in trigeminal neuralgia was the V2-V3, postherpetic V1, the most frequent antecedent of the neuralgias was the AHT, the type of pain that was more frequent was the lancinanting with 82.4%. The most commonly used medication was carbamazepine (60.5%) and pregabalin (29.4%); in surgical treatments radiofrequency was the most used in 32%; 30 patients had relapses that were generally managed with increased doses. This study shows a similarity with the reported literature, presenting more cases of trigeminal neuralgia, followed by the herpetic and finally the glossopharyngeal neuralgia, finding more cases in women than in men, with an average age of 60 years, affecting in Greater proportion the mandibular and maxillary branch in the trigeminal neuralgia and in the postherpetic ophthalmic.

Comparison of extraoral and intraoral routes of glossopharyngeal nerve block for pain relief in patient with carcinoma tongue: A prospective randomized study

Background and Objective: Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. Materials and Methods: This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Results: Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). Conclusion: The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB

Clinical study of microsurgery treatment for glossopharyngeal neuralgia in aged patients / 中华老年医学杂志

Objective To investigate the safety and efficacy of microsurgery for glossopharyngeal neuralgia in aged patients by analyzing short-term and long-term follow-up outcomes.Methods Clinical data of 55 glossopharyngeal neuralgia patients treated with microsurgery were retrospectively analyzed.Among them,25 patients aged over 65 years were assigned into the observation group,and 30 patients under 65 years were assigned into the control group.Clinical characteristics,postoperative complications,short-term efficacy and long-term prognosis were compared between the two groups.Results There was a significant difference in the average age between the observation group and the control group[(71.88 ± 5.95) years vs.(52.57 ± 5.88)years,(t =12.052,P＜0.001)].The incidence of concomitant diseases was higher in the observation group than in the control group (56.0 ％ vs.13.3 ％,x2 =9.421,P =0.001).No significant difference was found in length of hospital stay or postoperative complications between the two groups(t =0.268,P=0.551;x2=0.068,P =0.562).There was no significant difference in short-and long-term prognosis at 1,3,6 months and 1 year after microsurgery (P ＞ 0.05).Conclusions Clinical characteristics,prognosis after microsurgery and surgery risks in aged glossopharyngeal neuralgia patients are comparable to those in younger glossopharyngeal neuralgia patients.Therefore,microsurgery is safe and effective in treating glossopharyngeal neuralgia in aged patients and should be encouraged in clinical practice.

Lipoma Causing Glossopharyngeal Neuralgia: A Case Report and Review of Literature

The cerebello-pontine angle lipomas causing trigeminal neuralgia or hemifacial spasm are rare. A lipoma causing glossopharyngel neuralgia is also very rare. A 46-year-old woman complained of 2-year history of severe right throat pain, with ipsilateral episodic otalgic pain. The throat pain was described as an episodic lancinating character confined to the throat. Computed tomography and magnetic resonance imaging revealed a suspicious offending posterior inferior cerebellar artery (PICA) compressing lower cranial nerves including glossopharyngeal nerve. At surgery, a soft, yellowish mass (2x3x3 mm in size) was found incorporating the lateral aspect of proximal portion of 9th and 10th cranial nerves. Only microvascular decompression of the offending PICA was performed. Additional procedure was not performed. Her severe lancinating pain remained unchanged, immediate postoperatively. The neuralgic pain disappeared over a period of several weeks. In this particular patient with a fatty neurovascular lump causing glossopharyngeal neuralgia, microvascular decompression of offending vessel alone was enough to control the neuralgic pain.

Glossopharyngeal Neuralgia Secondary to Tongue Squamous Cell Carcinoma

No abstract available.

Duration of remission phase of 36 Korean patients with glossopharyngeal neuralgia / 대한마취과학회지

BACKGROUND: Glossopharyngeal neuralgia has the characteristic of a long remission phase between the pain attack phases. Although the concept of remission is very important for the treatment of patients with glossopharyngeal neuralgia, due to the rarity of the disease, clear statistical studies on the remission phase for glossopharyngeal neuralgia are almost non-existent. METHODS: Previous chart reviews and phone interviews were conducted on a total of 38 patients. Among these study subjects, two patients were excluded because of their known secondary glossopharyngeal neuralgia from their brain tumors. Hence, the average duration of remission was investigated on 36 patients with idiopathic glossopharyngeal neuralgia. RESULTS: For the 27 patients who experienced their first remission, the average duration of the remission was 3.1 years. Among them, the average duration of the second remission of the 17 patients was 2.5 years, and for 4 patients who experienced a third remission, the average duration of the remission phase was 1.9 years. CONCLUSIONS: The difference in the mean duration of the remission phase of the 1st, 2nd, and 3rd are not statistically significant, and the occurrence rate of the left or right side and of the gender, male or female, are also statistically insignificant. However, it is possible to infer that a patient might face a pain attack phase when his or her remission phase has lapsed for about three years. This prediction may be applied when developing treatment plans for patients with glossopharyngeal neuralgia.

Permanent Pacemaker Implantation in a Patient with Cardiac Syncope Associated with Glossopharyngeal Neuralgia / 대한내과학회지

Glossopharyngeal neuralgia is a rare disease that is characterized by sharp pain in the posterior pharynx, tonsils, and larynx, triggered by swallowing. Glossopharyngeal neuralgia can trigger bradycardia or asystole, which can induce life-threatening cardiac syncope. A 55-year-old male was admitted with severe paroxysmal pain in his left jaw and ear, followed by asystole and syncope. We report a patient with cardiac syncope associated with glossopharyngeal neuralgia treated with a permanent pacemaker.

Syncope Associated With Glossopharyngeal Neuralgia in B-Cell Lymphoma

No abstract available.

Permanent Pacemaker Implantation in a Patient with Cardiac Syncope Associated with Glossopharyngeal Neuralgia / 대한내과학회지

Glossopharyngeal neuralgia is a rare disease that is characterized by sharp pain in the posterior pharynx, tonsils, and larynx, triggered by swallowing. Glossopharyngeal neuralgia can trigger bradycardia or asystole, which can induce life-threatening cardiac syncope. A 55-year-old male was admitted with severe paroxysmal pain in his left jaw and ear, followed by asystole and syncope. We report a patient with cardiac syncope associated with glossopharyngeal neuralgia treated with a permanent pacemaker.

Glossopharyngeal Neuralgia Caused by Arachnoid Cyst in the Cerebellopontine Angle

Glossopharyngeal neuralgia is a relatively rare condition characterized by severe, paroxysmal episodes of lancinating pain in the tongue, throat, ear, and tonsil. This disorder is assumed to be due to compression of the glossopharyngeal nerve by vascular structures. A 47-year-old woman complaining of sharp and lancinating pain in the right periauricular and submandibular areas visited our hospital. Swallowing, chewing, and lying on her right side triggered the pain. Her neurologic examination revealed no specific abnormalities. The results of routine hematologic and blood chemistry studies were all within normal limits. Carbamazepine and gabapentin were given, but her symptoms persisted. Her pain was temporarily relieved only by narcotic pain medication. MRI showed an arachnoid cyst located in the right cerebellomedullary cistern extending to the cerebellopontine cistern. Cyst removal was performed via a right retrosigmoid approach. Lateral suboccipital craniotomy was performed using the right park-bench position. After opening the dura and cerebellopontine angle, the arachnoid cyst was exposed. The arachnoid cyst was compressing the flattened lower cranial nerves at the right jugular fossa. Her symptoms resolved postoperatively. Two months after the operation, she was completely free from her previous symptoms.

Severe Pain Attack Associated with Neurocardiogenic Syncope Induced by Glossopharyngeal Neuralgia: Successful Treatment with Carbamazepine and a Permanent Pacemaker: A Case Report

Glossopharyneal neuralgia (GPN) is generally considered to be a pain disease. However, it can be also be a life-threatening cardiac cause of syncope. Neuralgia in the throat and neck can trigger severe bradycardia up to the point of asystole, which can progress to cardiac syncope with or without seizures. A 65 year-old male patient diagnosed with glossopharyngeal neuralgia complained of severe paroxysmal pain in his right chin and ear followed by bradycardia, aystole and syncope. We report a case successfully treated with a permanent pacemaker and carbamazepine in a patient with GPN who had syncopal attacks preceded by paroxysms of pain.

Síndromes de compression neurovascular descompresión microvascular: nuestra experiencia (2003-2009) / Neurovascular compression syndroms microvascular decompression: our experience (2003-2009)

Objective. To present and evaluate the surgical results of microvascular decompression in the treatment of trigeminal neuralgia, glossopharyngeal neuralgia and hemifacial spasm. Material and Method. We present 15 patients with compressive syndrome of cranial nerve during a period of 6 years: 11 patients with trigeminal neuralgia, 2 patients with glossopharyngeal neuralgia and 2 patients with hemifacial spasm. Results. We achieved total improvement in 8 patients and partial in 4. The most frequent symptom after surgery was hypoesthesia in V2 in patients with trigeminal neuralgia. 3 patients presented temporary facial paresis. Conclusion. Microvascular decompression is an effective treatment with low morbidity in patients with compressive syndrome of cranial nerves. The goal of treatment should be complete disappearance of symptoms.

Microvascular decompression in treating cranial nerve diseases / 中国综合临床

Objective To study the efficacy of microvascular decompression in treating cranial nerve diseases. Methods 156 patients were treated with microvaseular decompression,of whom 119 were with trigeminal neuralgia,34 with hemifacial spasm and three with glossopharyngeal neuralgia.Rusults The overall effective rate was 96.8%(151/156) and the corresponding effective rate for the above three conditions were 94.2%,97.1% and 66.7%. Conlusions Mierovaseular decompression iS an effective treatment for cranial nerve diseases.

Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence

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.

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.

A Case of Glossopharyngeal Neuralgia after Tonsillectomy / 대한이비인후과학회지

Tonsillectomy is one of the most common procedures performed by an otorhinolaryngologist. Postoperative hemorrhage and dehydration are two of the most common complications, but glossopharyngeal neuralgia is an unusual complication encountered in tonsillectomy. Glossopharyngeal neuralgia is characterized by paroxysms of ipsilateral and severe lancinating pain occurring in the distribution of the nerve. The pain may be spontaneous or precipitated by a variety of actions that stimulate the region supplied by the glossopharyngeal nerve namely yawning, coughing, swallowing and talking. The proximity between the glossopharyngeal nerve and the tonsillar fossa suggests that dissection in the correct surgical plane during tonsillectomy is important for avoiding injury to the glossopharyngeal nerve. Glossopharyngeal neuralgia after tonsillectomy is induced by intraoperative cauterization, nerve compression or iatrogenic trauma. Management of glossopharyngeal neuralgia induced by tonsillectomy should be given a trial of anti-convulsant medication like carbamazepine or glossopharyngeal nerve resection. A case of glossopharyngeal neuralgia caused by tonsillectomy was experienced by a 29-year-old man, and this case was reported and its aetiology was discussed.

A Case of Atypical Trigeminal Neuralgia Mistaken as Glossopharyngeal Neuralgia: A case report / 대한마취과학회지

Trigeminal neuralgia (TGN) is a relatively well-known disorder with characteristic brief attacks of shooting pain in the facial regions. Atypical signs like constant pain and/or sensory abnormalities can develop as the disease progresses. Some cases begin with atypical signs and later develop all the hallmarks of TGN. The atypical forms of TGN can be misdiagnosed as other pain disorders. We present a patient with facial pain who demonstrated a transformation in signs of glossopharyngeal neuralgia into typical trigeminal neuralgia. A 71 year-old man was referred for sharp episodic pain in his right side of the face and neck. The pain was mainly in the neck, which was worsened especially by swallowing. The condition was initially diagnosed as a glossopharyngenl neuralgia. While controlling the pain conservatively with a sympathetic blockade, the neck pain disappeared suddenly and lower jaw pain triggered by speaking and chewing became prominent, which are the characteristic signs of trigeminal neuralgia.

Endoscopic Minimally Invasive Surgery for Primary Glosspharyngeal Neuralgia / 中国微创外科杂志

Objective To explore the outcomes of endoscopic minimally invasive surgery as a new technique for the treatment of glossopharyngeal neuralgia.Methods From January 2000 to May 2008,16 cases of primary glossopharyngeal neuralgia were treated by endoscopic minimally invasive surgery through suboccipital retrosigmoid approach in our hospital.We made a 6-to 8-cm vertical incision within the inner hairline to drain the cerebrospinal fluid from the cerebellopotine angle cistern(CPA) so that to form an operational path.And then,the adherent arachnoid membrane was freed and the structure of the glossopharyngeal nerve and local arteries were detected.Results After the endoscopic surgery,pharyngeal pain disappeared in all of the 16 cases.Follow-up was available for 3 months to 8 years in the patients(1-3 years in 4 cases,and 3-8 years in 2 cases).Two patients had hoarse voice after the operation.No one had dysphagia or recurrence during the follow-up.Conclusion Endoscopic surgery through suboccipital retrosigmoid approach is a minimally invasive method for primary glossopharyngeal neuralgia with good outcomes,mild surgery-related complications,and quick post-operative recovery.

Nucleus Caudalis DREZ Lesioning for Intractable Pain due to Invasive Sarcoma in Skull Base: Case Report

We present a case of nucleus caudalis DREZ operation for medically refractory facial pain due to invasive sarcoma in skull base. The patient showed excellent pain relief immediately after the operation. Until 5 month later, the pain was less than before surgery. At the point of view of pain characteristics and distribution, it was considered the trigemino-vago-glossopharyngeal neuralgia. It is suggested that the nucleus caudalis DREZ operation is effective in treating medically refractory facial pain due to invasive sarcoma in skull base.

Glossopharyngeal Nerve Block for Idiopathic Glossopharyngeal Neuralgia: A case report / 대한마취과학회지

Glossopharyngeal neuralgia (GPN) is a rare condition characterized by paroxysms of lancinating pain in the regions of the tonsil, ear, larynx and tongue. The pain is typically triggered by activities such as swallowing, speaking or coughing. Fifty-seven years old female patient had suffered paroxysms of severe pain in the unilateral region of the glossopharyngeal innervation for several years, and long term drug therapy result in serious pancytopenia probably due to carbamazepine. The patient with idiopathic glossopharyngeal neuralgia received glossopharyngeal nerve block and her symptoms were relieved completely. Glossopharyngeal nerve block with alcohol was done by extraoral approach and satisfactory results were obtained.