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Hemifacial spasm resulting from vertebral artery dolichoectasia
Dirk Deleu1, Boulenouar Mesraoua
1Department of Neurology (Medicine), Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar. Fax. +947 4392273.
Neurosciences (Riyadh, Saudi Arabia)
|April 5, 2012
Summary
A case of hemifacial spasm revealed an uncommon cause: vertebral dolichoectasia compressing the facial nerve. Magnetic resonance imaging (MRI) confirmed the diagnosis, and botulinum toxin injections provided symptom relief.
Area of Science:
- Neurology
- Neuroimaging
- Neurosurgery
Background:
- Hemifacial spasm is characterized by involuntary contractions of facial muscles.
- Neurovascular compression of the facial nerve is a common etiology.
- Less common causes, such as vertebral artery anomalies, require thorough investigation.
Purpose of the Study:
- To report a case of hemifacial spasm caused by vertebral dolichoectasia.
- To highlight the diagnostic utility of MRI/MRA in such cases.
- To discuss vertebral dolichoectasia as an uncommon cause of hemifacial spasm.
Main Methods:
- Clinical presentation of a 32-year-old male with left hemifacial spasm.
- Neurophysiological assessment including blink reflex (R1 response).
- Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) to evaluate the facial nerve and vertebral artery.
Main Results:
- Absent ipsilateral R1 blink reflex response.
- MRI revealed a dolichoectatic left vertebral artery impinging on the left facial nerve root.
- Botulinum toxin injections successfully alleviated hemifacial spasm symptoms.
Conclusions:
- Vertebral dolichoectasia can be an uncommon cause of hemifacial spasm.
- MRI/MRA are crucial for diagnosing neurovascular compression in hemifacial spasm.
- This case underscores the importance of considering vascular anomalies in refractory or atypical presentations.
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