Bilateral painful tic convulsif.

Area of Science:

• Neurology
• Neurosurgery

Background:

• Painful tic convulsif (PTC) is characterized by the concurrent occurrence of hemifacial spasm and trigeminal neuralgia.
• Neurovascular conflict, where cranial nerves are compressed by blood vessels, is a common etiology for these conditions.

Observation:

• This report details a rare case of bilateral PTC in a male patient presenting with bilateral hemifacial spasm and trigeminal neuralgia.
• The patient's symptoms were attributed to neurovascular conflict involving all four cranial nerves.

Findings:

• Medical and radiofrequency therapies were ineffective for the patient.
• Microvascular decompression was performed on three of the four affected cranial nerves, repositioning offending vessels and using Teflon to prevent recurrence.
• The patient achieved complete bilateral pain relief and resolution of left-sided spasms post-surgery.
• Botox injections continue to manage residual right-sided hemifacial spasm.

Implications:

• Microvascular decompression is a viable surgical option for complex and bilateral cases of painful tic convulsif refractory to conservative treatments.
• This case highlights the potential for successful surgical intervention in managing severe neurovascular compression syndromes affecting multiple cranial nerves.
• Further research into tailored surgical approaches for bilateral PTC may improve patient outcomes and quality of life.