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Mayo Clin Proc. 2010 March; 85(3): 209.
PMCID: PMC2843110

A Painful Pause

An 83-year-old man had lancinating throat pain, triggered by swallowing, coughing, and even speaking. He would pass out with excruciating pain. Magnetic resonance imaging showed an abnormal posterior inferior cerebellar artery loop (PICA) (left, arrow) exiting the brainstem (left, arrowhead), near the left glossopharyngeal and vagus nerves. Arterial compression from the posterior inferior cerebellar artery on the cranial nerves could produce demyelination, resulting in abnormal cross-conduction. Pain and syncope disappeared with carbamazepine treatment. Severe pain can cause vasovagal syncope,1 but direct vagal stimulation was responsible for asystole in our patient (right). A pacemaker will not prevent syncope if pain is associated with a vasovagal response.2

figure 209.fig

References

1. Ferranti L, Artico M, Nardacci B, Fraioli B, Cosentino F, Fortuna A. Glossopharyngeal neuralgia with cardiac syncope. Neurosurgery 1995;36:58-63 [PubMed]
2. Wallin BG, Westerberg CE, Sundlöf G. Syncope induced by glossopharyngeal neuralgia: sympathetic outflow to muscle. Neurology 1984;34:522-524 [PubMed]

Articles from Mayo Clinic Proceedings are provided here courtesy of The Mayo Foundation for Medical Education and Research