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In the case described, electroencephalography (EEG) proved valuable for determining the nature of spells of loss of consciousness with brief clonic jerks associated with ear and throat pain. A 70-year-old woman had a history of episodic brief attacks of pain below the right ear and deep in the neck that had started three years previously. The spells became more severe and progressed to loss of awareness associated with clonic jerks of the extremities. Because of a concern that the spells represented seizures, an EEG was performed, with electrocardiographic monitoring. Multiple spells were recorded; they began with profound bradycardia followed by generalized slow-wave activity and then by suppression of all EEG activity correlating with loss of consciousness and clonic jerking. The spells were thought to represent syncopal attacks associated with glossopharyngeal neuralgia.

In 217 cases of glossopharyngeal neuralgia seen at the Mayo Clinic between 1922 and 1977, the disease was more common in patients older than 50 years (57%), but also occurred in 43% who were between 18 and 50. Spontaneous remissions were noted by 161 patients, but 37 had no periods of pain relief. Syncope was rarely a problem. Involvement was bilateral in 12%. The combination of glossopharyngeal and trigeminal neuralgia was found in 25 patients. Positive results on the cocaine test in 112 of 125 patients aided in diagnosis. Carbamazepine is the favored medication. Early surgical experience consisted of extracranial avulsion of the glossopharyngeal nerve or intracranial section at the jugular foramen; since 1948, surgical treatment has included section of the glossopharyngeal nerve and usually the upper rootlets of the vagus nerve and additional section of the fifth cranial nerve when trigeminal neuralgia was associated. Good relief of pain was obtained surgically in 110 patients.