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Neurological Rehabilitation

Acute Onset of Glossopharyngeal Neuralgia in a Patient with Metastatic Lesions in the Cerebellum

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 7

    Poster Presenter(s)

  • Ben Birkenfeld, MD

    Resident
    JFK Medical Center PM&R Program
    Fort Lee, New Jersey

    • Co-Author(s)

  • IJ

    Iqbal H. Jafri, MD (he/him/his)

    Professor, Hackensack Meridian School of Medicine; Medical Director Center for Cardiopulmonary Rehab
    Jfk Johnson Rehabilitation Institute
    Edison, New Jersey

Disclosure(s):
Ben Birkenfeld, MD: No financial relationships to disclose
Case Diagnosis: Postoperative Development of Glossopharyngeal Neuralgia

Case Description or Program Description: A 68-year-old female with no past medical history presented to the hospital for severe bilateral headaches. Initial brain imaging with CT and MRI demonstrated four enhancing lesions with cerebellar metastatic mass effect resulting in downward herniation and ventriculomegaly. The patient underwent surgical resection of the tumors, with further oncologic workup suggesting lung cancer primary with metastases. Postoperatively, the patient had limited food intake, which she attributed to severe sharp, burning pain in her gums, tongue, and throat. Due to her pain and limited food intake, the patient experienced fatigue and lethargy, limiting her ability to participate in rehabilitation therapies. Speech language pathology and dental evaluations did not reveal an underlying cause for her symptoms. Given the nature and distribution of her symptoms, a diagnosis of glossopharyngeal neuralgia was considered. She was started on carbamazepine 200mg BID and experienced significant improvement in her symptoms within 24 hours.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: A patient with metastatic brain lesions underwent neurosurgical intervention. In the immediate postoperative period, she developed severe neuropathic pain in the glossopharyngeal nerve distribution, limiting her oral intake and hindering her ability to participate in rehabilitation. Treatment with carbamazepine resulted in alleviation of her symptoms.

Discussion (relevance): Glossopharyngeal neuralgia is a rare diagnosis that is generally caused by tumors, infections, or other compressive etiologies. Here, we demonstrate a case in which symptoms presented in the acute postoperative period, potentially related to inflammation, anatomical changes, or edema, among other diagnoses.

Conclusions: Accurate diagnosis and treatment of glossopharyngeal neuralgia is crucial for improving patient outcomes. The diagnosis is made primarily from the history and physical examination, with medical therapy remaining as the first line treatment.