One morning when 40 years old female called her daughter, she felt slight pain in her throat. In the after on the same day, she felt a little stronger pain in her throat when she drank water. After that, the pain in her throat occurred repeatedly.
One month after she started to feel the pain in her throat, she felt a severe pain in her left ear when she sneezed. The pain was like the inner ear was pierced by a lot of hot needles. The severe pain calmed down in 15 seconds. But when she swallowed saliva, the severe pain started again. She went to a otorhinologist (nose and ear doctor), but nothing abnormal was found and the doctor suggested the possibility of shingles. Shingles is caused by the varicella zoster virus and appears in a band on the skin. It can be triggered by stress or weakness of the immune system. She was prescribed with pain killer and antivirals, but there was no improvement. The cycle of the pain became shorter and she felt the pain every 1 minute even while sleeping. She was in a mentally tight spot due to the pain.
She had various kinds of tests in various hospitals, but the cause of the pain was not found. In the department of neurosurgery, MRI was taken but nothing was found and very strong pain killer was prescribed. The strong pain killer removed the pain but she started to feel strong tiredness. The cause of the strong tiredness was lowered liver function so she was unable to be prescribed with the strong pain killer any longer.
Then she was referred to a specialist of neurology in a hospital. Since MRI, CT or X-ray cannot image nerves mostly, various tools are used in neurology to check nerves. First, the brainstem was tested. If there is any abnormality in the brainstem, there should be some abnormality in the limbs. But there was no abnormality. After that, all the nerves that could be affected were checked. Trigeminal nerves were tested. Blinking shows sensitive reaction of trigeminal nerves. If the movement of blinking is slow, the abnormality of trigeminal nerves is suspected, but there was no abnormality. The last nerve not tested yet was glossopharyngeal nerve. MRI is unable to image nerves but MRI was taken again focusing on something around the glossopharyngeal nerve.
Fig. 1 is her actual MRI image. Only one side of the blood vessel by the glossopharyngeal nerve is thick. This was the cause of the severe pain. The disease was glossopharyngeal neuralgia. Hardening of the blood vessel located by the glossopharyngeal nerve occurs and the thickened blood vessel presses the glossopharyngeal nerve, causing a severe pain. She was released from the severe pain by the surgery to separate the blood vessel from the glossopharyngeal nerve.
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