Teaching Video NeuroImages: Vagoglossopharyngeal neuralgia mimicking a seizure.

A 79-year-old woman with a history of partial thyroidectomy for multinodular goiter presented with acute onset episodic left ear pain followed by collapse with loss of awareness and limb jerking. Video EEG captured stereotyped episodes (video, links.lww.com/WNL/A287) with corresponding bradycardia and asystole for several seconds without ictal changes. A diagnosis of vagoglossopharyngeal neuralgia was made. She became symptom-free with eslicarbazepine and pacemaker insertion.

Approximately 10% of patients with glossopharyngeal neuralgia experience bradycardia and syncope. Activation of the vagus nerve (dorsal motor nucleus) by excessive input from the glossopharyngeal nerve (via tractus solitarius) may lead to potential cardiac arrhythmias.