Sakaguchi A, Nagashima C, Kamisasa A, Kawanuma S
No Shinkei Geka. 1977 Jan;5(1):89-94.
A 74-year-old female who complained of severe attacks of pain in the throat and neck on the left side was first admitted to our hospital in 1971. Carbamazepine was effective at this time, and so she could be discharged. She was readmitted to the hospital in 1974 because of severe stabbing paroxysms of pain in the left throat, radiating into the auricular region as frequent as more than ten times a day. Paroxysms could not be alleviated by large doses of Carbamazepine, and side effects of the drug ensued. The pain could be easily elicited by talking, laughing, swallowing, pulling the left ear and pushing the left tragus. Block of the left 9th nerve with xylocaine produced complete relief of pain for 30 minutes to 1 hour; Plain skull X-rays and veretebral angiograms were normal. The patient was operated under general anesthesia in the sitting position. With the left suboccipital craniectomy, the left 9th nerve was cut without any change on ECG. Pulse rate, and blood pressure. Upon touching vagus nerve, the ventricular extrasystole and hypotension occurred. After the blood pressure restored to normal level and the extrasystole disappeared with administration of atropine and carnigen, the uppermost rootlet of the vagus nerve was cut. The blood pressure dropped abruptly again followed by the right bundle-branch block on ECG for approximately 20 minutes. Postoperatively, she was lethargic and had disorientation, delusion and disorientation. We attributed these symptoms to the hypoxia in operative procedure. The symptoms completely disappeared on the fifth postoperative day. The patient has been perfectly free from pain at the 15 month's follow-up without neurological or mental deficit except diminished gag reflex on the left side. We reported this our experienced case and discussed about the mechanism of the hypotension on sectioning a rootlet of the vagus nerve with literatures.
一名74岁女性，主诉左侧咽喉和颈部剧痛发作，于1971年首次入住我院。当时卡马西平有效，因此她得以出院。1974年，她因左侧咽喉剧烈刺痛性发作再次入院，疼痛放射至耳部区域，每天发作多达十几次。大剂量卡马西平无法缓解发作，且出现了药物副作用。说话、大笑、吞咽、牵拉左耳和按压左耳屏均可轻易诱发疼痛。用利多卡因阻滞左侧第9神经可使疼痛完全缓解30分钟至1小时；头颅平片和椎动脉造影均正常。患者在坐位全身麻醉下接受手术。行左侧枕下颅骨切除术，切断左侧第9神经，心电图、脉搏率和血压均无变化。触碰迷走神经时，出现室性早搏和低血压。经阿托品和卡尼丁治疗，血压恢复正常水平且早搏消失后，切断迷走神经最上方的神经根。血压再次突然下降，随后心电图出现右束支传导阻滞约20分钟。术后，她嗜睡，有定向障碍、妄想和精神错乱。我们将这些症状归因于手术过程中的缺氧。这些症状在术后第5天完全消失。在15个月的随访中，患者完全没有疼痛，除左侧咽反射减弱外，无神经或精神缺陷。我们报告了这一经验病例，并结合文献讨论了切断迷走神经根时低血压的机制。
