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Neurology Resident and Fellow Section Episodic ear pain leading to loss of consciousness and limb jerking Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Vignette A 79-year-old woman with a background history of partial thyroidectomy for multinodular goitre presented with acute onset of ear pain followed by collapse with loss of consciousness and limb jerking (multiple episodes daily). Chalissery et al. © 2017 American Academy of Neurology

Video Video 1 title: Vagoglossopharyngeal neuralgia mimicking as a seizure Video 1 legend: Stridorous breathing at rest (secondary to recurrent laryngeal nerve palsy), restlessness due to pain in the ear, leading to bilateral tonic posturing with eyes open. A brief period of unresponsiveness on a background of bradycardia and asystole for few seconds in EKG. Chalissery et al. © 2017 American Academy of Neurology

Vagoglossopharyngeal neuralgia mimicking as a seizure Video EEG captured stereotyped episodes of ear pain with corresponding bradycardia and asystole for several seconds without any ictal discharges in EEG. A diagnosis of vagoglossopharyngeal neuralgia was made. Patient became symptoms free with eslicarbazepine and insertion of a pacemaker. Approximately 10 % of patients with glossopharyngeal neuralgia experience bradycardia and syncope1. Activation of the vagus nerve (dorsal motor nucleus) by excessive input from the glossopharyngeal nerve (via tractus solitarius) may lead to potential cardiac arrhythmias2. References 1. Blumenfeld A, Nikolskaya G. Glossopharyngeal neuralgia. Curr Pain Headache Rep 2013;17(7):343 2. Varrasi C, Strigaro G, Prandi P et al. Complex pattern of convulsive syncope in glossopharyngeal neuralgia: Video/EEG report and short review. Epilepsy Behav 2011;20(2):407-409 Chalissery et al. © 2017 American Academy of Neurology