[Glossopharyngeal neuralgia associated with the right-bundle branch block and hypotension on sectioning a rootlet of the vagus nerve--case report (author's transl)].
A 74-year-old female who complained of severe attacks of pain in the throat and neck on the left side was first admitted to our hospital in 1971. Carbamazepine was effective at this time, and so she could be discharged. She was readmitted to the hospital in 1974 because of severe stabbing paroxysms of pain in the left throat, radiating into the auricular region as frequent as more than ten times a day. Paroxysms could not be alleviated by large doses of Carbamazepine, and side effects of the drug ensued. The pain could be easily elicited by talking, laughing, swallowing, pulling the left ear and pushing the left tragus. Block of the left 9th nerve with xylocaine produced complete relief of pain for 30 minutes to 1 hour; Plain skull X-rays and veretebral angiograms were normal. The patient was operated under general anesthesia in the sitting position. With the left suboccipital craniectomy, the left 9th nerve was cut without any change on ECG. Pulse rate, and blood pressure. Upon touching vagus nerve, the ventricular extrasystole and hypotension occurred. After the blood pressure restored to normal level and the extrasystole disappeared with administration of atropine and carnigen, the uppermost rootlet of the vagus nerve was cut. The blood pressure dropped abruptly again followed by the right bundle-branch block on ECG for approximately 20 minutes. Postoperatively, she was lethargic and had disorientation, delusion and disorientation. We attributed these symptoms to the hypoxia in operative procedure. The symptoms completely disappeared on the fifth postoperative day. The patient has been perfectly free from pain at the 15 month's follow-up without neurological or mental deficit except diminished gag reflex on the left side. We reported this our experienced case and discussed about the mechanism of the hypotension on sectioning a rootlet of the vagus nerve with literatures.
D000368:Aged; D002037:Bundle-Branch Block / Q000209:etiology*; D005260:Female; D005930:Glossopharyngeal Nerve / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D009437:Neuralgia / Q000601:surgery*; D014628:Vagotomy / Q000009:adverse effects*