Coexistence of glossopharyngeal neuralgia with atypical trigeminal neuralgia in a young girl

      Trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN) are characterized by sudden, severe, paroxysmal, usually unilateral craniofacial pain. Due to similar clinical presentations the coexistence of GPN may be misdiagnosed. Here, we present a case of a 17 year-old female with refractory TN, who was found to have coexistent GPN by diagnostic blockage of the ninth cranial nerve. This case is extremely rare, as TN and GPN rarely coexist and only a small percentage of TN or GPN cases occur under the age 20. Our patient is a 17 year-old morbidly obese female who had suffered from left sided facial pain for four years. She had been hospitalized numerous times for the facial pain, which she described as sharp and electrical shock-like pain. Her medical management began with carbamazepine and lyrica. Initially, her pain improved and seemed to be well controlled. However, on several occasions she had a relapse of facial pain on the higher dose of medications. Ten months after her initial admission, she suffered her most severe and refractory facial pain. She underwent MRI and MRA of the brain which were negative. Given her atypical symptoms and past history of tonsillectomy, the concurrent glossopharyngeal nerve involvement was suspected. Diagnostic blockage of the ninth cranial nerve was performed and patient reported a 0 out of 10 pain. Her planned surgical operation was revised to decompression of the fifth and ninth cranial nerve. The patient underwent left-sided microscopic decompression of trigeminal and glossopharyngeal nerve under neuromonitoring and neuronavigation. At her eight-week and three-month follow-up, she was completely pain-free. The coexistence of GPN is often misdiagnosed in patients with TN because of their similarities in clinical presentation and overlapping symptoms. Therefore, any patient with refractory or atypical TN, should be evaluated for underlying GPN.