Vascular compression, hemifacial spasm, and multiple cranial neuropathy.

Area of Science:

• Neurology
• Neurosurgery

Background:

• Hemifacial spasm typically arises from isolated facial nerve root compression.
• This study investigates atypical presentations of hemifacial spasm.

Observation:

• Three patients presented with hemifacial spasm alongside tinnitus, hearing loss, facial sensory loss, diminished gag reflex, dysphagia, and dysarthria.
• Abnormal acoustic reflexes and abnormal facial nerve conduction studies indicated ephaptic transmission and ectopic excitation.
• Standard neuroimaging (Brain CT, metrizamide cisternography) yielded normal results.

Findings:

• Surgical exploration revealed compression of cranial nerve roots by branches of the posterior inferior cerebellar artery.
• Symptomatic improvement and resolution of electrophysiological signs of hemifacial spasm occurred after surgical decompression.

Implications:

• Vascular compression of cranial nerve roots in the cerebellopontine recess is a potential cause of multiple cranial neuropathies.
• Surgical decompression is an effective treatment for neurovascular compression presenting as hemifacial spasm and associated cranial nerve deficits.