Một người đàn ông 36 tuổi phát triển tập đau chụp sắc nét, liên quan đến cổ họng của mình và tai giữa bên trái mà đôi khi kết tủa bằng cách nhai và nuốt boluses lớn các thực phẩm rắn như bít tết mà còn xảy ra mà không có hành động khiêu khích rõ ràng. | 169 Correct Answer The correct answer is A. Following injury of the facial nerve regenerating parasympathetic fibers destined to the salivary glands misdirect their growth and join the postganglionic sympathetic fibers in the auriculotemporal nerve that innervate the preauricular sweat glands. This results in pathologic preauricular sweating Frey syndrome . 6. A 36-year-old man develops episodes of sharp shooting pain involving his throat and left middle ear that are sometimes precipitated by chewing and swallowing large boluses of solid food such as steak but also occur without obvious provocation. Most of the time they are also associated with lightheadedness or outright syncope due to a sudden drop in blood pressure. He is afraid to drive because of this problem and has had multiple sudden falls with injury due to syncope. Various evaluations have ruled out macroscopic lesions of the throat or thorax. Trials of medication have not been useful. Surgical transection of which of the following structures is most likely to stop his refractory syncopal spells A. Cervical sympathetic chain B. Glossopharyngeal nerve C. Pharyngeal branches of vagus nerve D. Trigeminal ganglion E. Trigeminal nerve Correct Answer The correct answer is B. Glossopharyngeal neuralgia is typically associated with pain or paresthesias referred to the throat or middle ear region which is the region of glossopharyngeal nerve innervation. Occasionally these attacks will be associated with a sudden drop in blood pressure due to bradycardia and or loss of vasomotor tone. Antiepileptic medications may help but in the case of refractory attacks of syncope sectioning of the glossopharyngeal nerve may be beneficial. 7. A 38-year-old man is evaluated for episodes of paroxysmal hypertension. Neurologic examination reveals a left Horner syndrome and magnetic resonance angiogram reveals a left internal carotid artery dissection. In this patient hypertension can be explained by lack of baroreceptor input to
