Thread by @hyderabaddoctor

Case of a man who almost stopped eating and drinking, as the act of swallowing caused severe throat pain

1. 45-year old man presented with intense episodes of pain in throat, back of tongue and tonsils on the right side for three months. The pain radiated to ear.
#MedTwitter

2. #pain was excruciating and was triggered by eating, chewing or swallowing food, drinking water, sneezing or even yawning. Pain lasted for 30-45 seconds and occurred 10-15 times every hour. He was so scared to eat or drink that he lost 15 kg weight in those 3 months.

3. He consulted ENT and dental doctors, and detailed examination by them was normal.
He became depressed and also had suicidal thoughts. He consulted psychiatrist and was started on anti-depressant medications.
On his sister's (a medico) advice, he decided to take my opinion.

4. Review of his symptoms suggested a diagnosis of #glossopharyngeal (the ninth cranial nerve that supplies sensation to back of throat) #neuralgia.
MRI brain showed a blood vessel compressing the nerve.
I started him on appropriate medication and asked to review after 10 days.

5. On review, his symptoms had remarkably reduced. Another month later, he was full of smiles and was completely pain-free. He was able to properly eat and drink and had also gained 5 kg weight.

6. Take home message
a. Sharp shooting episodic pain in the back of tongue, tonsils and throat exacerbated by chewing or swallowing is suggestive of glossopharyngeal neuralgia.
b. Medical treatment would result in excellent relief from pain in most cases.