Glossopharyngeal neuralgia triggered by non-noxious stimuli at multiple cephalic and extracephalic sites.
Glossopharyngeal neuralgia (GN) triggered by non-noxious stimuli at multiple cephalic and extracephalic sites with positron emission tomography (PET) evidence for involvement of the upper brainstem has never been reported. We present such a patient, a 73-year-old man who since the age of 50 had suffered from GN with a high recurrence rate and very severe unilateral, non-familial GN episodes with very easy trigger zones widely extending beyond the n IX territory. Extensive neuroimaging and neurophysiological tests detected no precise underlying cause. PET scan revealed activation in the upper brainstem on extracephalic triggers. Single-fibre electromyography data will be discussed. We hypothesize that deficient inhibition as seen in trigeminal nociceptive reflexes on the level of brainstem interneurons, a functional lesion in the primary somatosensory cortex-sensory thalamic nuclei circuit and the dorsal column-thalamic pathway both activated by light touch may in part be involved in the extracephalic triggering.
ter Berg
J W M
JW
Orbis Medical Centre, 6130 MB Sittard-Geleen, The Netherlands. h.terberg@orbisconcern.nl
Dupont
P
P
Schoenen
J
J
D000368:Aged; D001933:Brain Stem / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001026:Coronary Artery Bypass; D004576:Electromyography; D020435:Glossopharyngeal Nerve Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D009434:Neural Pathways / Q000503:physiopathology*; D049268:Positron-Emission Tomography