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Concurrent Glossopharyngeal Neuralgia and Hemi-Laryngopharyngeal Spasm (HeLPS): A Case Report and a Review of the Literature.

Hemi-laryngopharyngeal spasm (HeLPS) has been not too long ago described however isn’t but well known. Sufferers describe intermittent coughing and choking and could be cured following microvascular decompression of their Xth cranial nerve. This case report and literature overview spotlight that HeLPS can co-occur with glossopharyngeal neuralgia (GN) and has been beforehand described (however not acknowledged) within the neurosurgical literature.A affected person with GN and extra signs suitable with HeLPS is introduced. The affected person reported left-sided, intermittent, swallow-induced, extreme electrical ache radiating from her ear to her throat (GN).
She additionally reported intermittent extreme coughing, throat contractions inflicting a way of suffocation, and dysphonia (HeLPS). All her signs resolved following a left microvascular decompression of a loop of the posterior inferior cerebellar artery that was pulsating in opposition to each the IXth and Xth cranial nerves. A overview of the senior creator’s database revealed one other affected person with this mix of signs. A global literature overview discovered 27 sufferers have been beforehand described with signs of GN and the extra (however not acknowledged on the time) signs of HeLPS.
This overview highlights that sufferers with signs suitable with HeLPS have been reported since 1926 in no less than Four languages. This extra proof helps the rising recognition that HeLPS is one other neurovascular compression syndrome. Sufferers with HeLPS proceed to be misdiagnosed as conversion dysfunction. The elevated recognition of this new medical situation would require neurosurgical remedy and may alleviate the struggling of those sufferers.

Defining the Anatomy of the Vagus Nerve and Its Scientific Relevance for the Neurosurgical Remedy of Glossopharyngeal Neuralgia.

The neurosurgical remedy of glossopharyngeal neuralgia consists of microvascular decompression or rhizotomy of the nerve. When contemplating open part of the glossopharyngeal nerve, quite a few authors have advisable further sectioning of the ‘higher rootlets’ of the vagus nerve as a result of these fibers can sometimes carry the ache fibers inflicting the affected person’s signs. Sacrifice of vagus nerve rootlets, nevertheless, carries the potential danger of dysphagia and dysphonia.
On this examine, the anatomy and physiology of the vagus nerve rootlets are characterised to offer steering for surgical decision-making. Twelve sufferers who underwent posterior fossa craniotomy with intraoperative electrophysiological monitoring of the vagus nerve rootlets had been included on this examine. Within the 7 sufferers with glossopharyngeal neuralgia, the medical outcomes and problems had been additional analyzed. In half of the sufferers, electrophysiological information demonstrated pure sensory perform within the rostral rootlet(s) of the vagus nerve and motor responses in its caudal rootlets.
This orientation of the vagus nerve, with some pure sensory perform in its most rostral rootlet(s), was outlined as Kind A. Within the different half of sufferers, all vagus nerve rootlets (together with essentially the most rostral) had motor responses. This was outlined as Kind B. The surgical technique was guided by whether or not the affected person had a Kind A or Kind B vagus nerve. For these with Kind B, no vagus nerve rootlets had been sacrificed.
Not one of the sufferers with glossopharyngeal neuralgia developed any everlasting neurological deficits. We suggest intraoperative electrophysiological testing of the vagus nerve rootlets. If the testing reveals motor innervation within the rostral vagal rootlet (Kind B), that rootlet could also be decompressed however shouldn’t be sectioned to keep away from a motor complication. Sufferers with pure sensory innervation of the rostral rootlet(s) (Kind A) can have decompression or part of these rootlets with out complication.

The Vagus and Glossopharyngeal Nerves in Two Autonomic Issues.

The glossopharyngeal and vagus cranial nerves present the brainstem with sensory inputs from totally different receptors within the coronary heart, lung, and vasculature. This afferent info is vital for the short-term regulation of arterial blood strain and the buffering of emotional and bodily stressors. Glossopharyngeal afferents provide the medulla with steady mechanoreceptive alerts from baroreceptors on the carotid sinus.
Vagal afferents ascending from the center provide mechanoreceptive alerts from baroreceptors in numerous reflexogenic areas together with the aortic arch, atria, ventricles, and pulmonary arteries. In the end, afferent info from every of those distinct strain/quantity baroreceptors is all relayed to the nucleus tractus solitarius, built-in inside the medulla, and used to quickly alter sympathetic and parasympathetic exercise again to the periphery. Lesions that selectively destroy the afferent fibers of the vagus and/or glossopharyngeal nerves can interrupt the transmission of baroreceptor signaling, resulting in excessive blood strain fluctuations.
Vagal efferent neurons venture again to the center to offer parasympathetic cholinergic inputs. When activated, they set off profound bradycardia, scale back myocardial oxygen calls for, and inhibit acute irritation. Impairment of the efferent vagal fibers appears to play a task in stress-induced neurogenic coronary heart illness (i.e., takotsubo cardiomyopathy). This centered overview describes: (1) the significance of the vagus and glossopharyngeal afferent neurons in regulating arterial blood strain and coronary heart fee, (2) how greatest to evaluate afferent and efferent cardiac vagal perform within the laboratory, and (3) two medical phenotypes that come up when the vagal and/or glossopharyngeal nerves don’t survive improvement or are functionally impaired.

A Case of Remoted Unilateral Glossopharyngeal Nerve Palsy.

Remoted palsy of the glossopharyngeal nerve is uncommon. We report the case of an aged affected person with unilateral proper glossopharyngeal nerve palsy secondary to further cranial ischemia. On examination there was no different deficit apart from an absent proper gag reflex. We recognized her with ischemic stroke of the ninth nerve clinically and elevated her every day dose of Aspirin from 81 mg to 325 mg. The magnetic resonance imaging of the mind confirmed a traditional brainstem and cerebellum with patent intracranial circulation. Complete decision of the paralysis was seen two months later.
The potential mechanisms suspected are diabetic or hypertensive stenosis of the vasa nervorum or compression of the ninth nerve by an inside carotid artery dissection or aneurysm. This text discusses the assorted etiologies and mechanisms of this uncommon situation. It’s distinctive due to the nerve’s location and relation to different buildings.

Ultrasound-guided glossopharyngeal nerve block through the styloid course of for glossopharyngeal neuralgia: a retrospective examine.

To look at the effectiveness and security of ultrasound-guided glossopharyngeal nerve block through the styloid course of for main glossopharyngeal neuralgia.This retrospective examine included all sufferers receiving glossopharyngeal nerve block through the styloid course of underneath ultrasound steering for main glossopharyngeal neuralgia between January 2015 and Might 2018 at our hospital. The first final result of the examine was ache reduction as assessed utilizing the visible analog scale (VAS).
Remedy was thought-about efficient if the VAS rating decreased by greater than 2 factors.Twelve sufferers had been included within the evaluation. The baseline VAS scores ranged from 5 to 9. All sufferers acquired earlier pharmacotherapy. Different earlier remedies included pulsed mode radiofrequency (n=4), microvascular decompression (n=2), and glossopharyngeal nerve block (not underneath ultrasound steering; n=2).
The sufferers accomplished a complete of 48 injections for glossopharyngeal nerve block. At discharge from the hospital, and at 6, 12, and 18 months thereafter, 10/12, 10/12, 7/12, and 4/12 sufferers achieved ache reduction and the efficient fee was 83.3% at discharge, 83.3% at 6 months, 58.3% at 1 12 months, and 33.3% at 18 months, respectively.Ultrasound-guided glossopharyngeal nerve block through the styloid course of is a protected, radiation-free, repeatable, handy, and efficient remedy. It will probably present a remedy possibility for sufferers with glossopharyngeal neuralgia.
Alexander Sanchez