Hemifacial spasm due to vertebrobasilar dolichoectasia: a case report

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Abstract

Hemifacial spasm (HFS) happens because of vascular compression of the facial nerve at the root exit zone. Vertebrobasilar dolichoectasia (VBD) is a very rare cause of HFS. VBD is diagnosed by computed tomography angiography and magnetic resonance imaging. Here, we report a case of 65-year-old female patient with HFS due to VBD. We discuss the complications and the treatment options for the case.

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Hemifacial spasm: clinical findings and treatment.

J. Jankovic, S Wang (1998)

Hemifacial spasm (HFS) is a peripherally induced movement disorder characterized by involuntary, unilateral, intermittent, irregular, tonic or clonic contractions of muscles innervated by the ipsilateral facial nerve. We reviewed the clinical features and response to different treatments in 158 patients (61% women) with HFS evaluated at our Movement Disorders Clinic. The mean age at onset was 48.5+/-14.1 years (range: 15-87) and the mean duration of symptoms was 11.4+/-8.5 (range: 0.5-53) years. The left side was affected in 56% instances; 5 patients had bilateral HFS. The lower lid was the most common site of the initial involvement followed by cheek and perioral region. Involuntary eye closure which interfered with vision and social embarrassment were the most common complaints. HFS was associated with trigeminal neuralgia in 5.1% of the cases and 5.7% had prior history of Bell's palsy. Although vascular abnormalities, facial nerve injury, and intracranial tumor were responsible for symptoms in some patients, most patients had no apparent etiology. Botulinum toxin type A (BTX-A) injections, used in 110 patients, provided marked to moderate improvement in 95% of patients. Seven of the 25 (28%) patients who had microvascular decompression reported permanent complications and the HFS recurred in 5 (20%). Although occasionally troublesome, HFS is generally a benign disorder that can be treated effectively with either BTX-A or microvascular decompression.

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Vertebrobasilar dilatative arteriopathy (dolichoectasia).

Louis Caplan, Min Lou (2009)

Dolichoectasia (dilatative arteriopathy) describes marked elongation, widening, and tortuosity of arteries. The intracranial vertebral and basilar arteries are preferentially involved. Dolichoectatic arteries usually have an abnormally large external diameter and a thin arterial wall, with degeneration of the internal elastic lamina, multiple gaps in the internal elastica, thinning of the media secondary to reticular fiber deficiency, and smooth muscle atrophy. The most important clinical presentations of dilatative arteriopathy include acute brain ischemia; a progressive course related to compression of cranial nerves, the brain stem, or the third ventricle; and catastrophic outcome caused by vascular rupture. Flow in dilated arteries can become bidirectional, resulting in reduced antegrade flow and thrombus formation. Elongation and angulation of arteries can stretch and distort the orifices of arterial branches, leading to decreased blood flow, especially in penetrating branches.

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Microvascular decompression for hemifacial spasm.

E-h Jho, Peter J. Jannetta, M Larkins … (1995)

The authors report the results of 782 microvascular decompression procedures for hemifacial spasm in 703 patients (705 sides), with follow-up study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% were women; their mean age was 52 years, and the mean preoperative duration of symptoms was 7 years. The onset of symptoms was typical in 92% and atypical in 8%. An additional 57 patients who had undergone prior microvascular decompression elsewhere were analyzed as a separate group. Patients were followed prospectively with annual questionnaires. Kaplan-Meier methods showed that among patients without prior microvascular decompression elsewhere, 84% had excellent results and 7% had partial success 10 years postoperatively. Subgroup analyses (Cox proportional hazards model) showed that men had better results than women, and patients with typical onset of symptoms had better results than those with atypical onset. Nearly all failures occurred within 24 months of operation; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, whether the first procedure was performed at Presbyterian-University Hospital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and preoperative duration of symptoms, history of Bell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results. Complications after the first microvascular decompression for hemifacial spasm included ipsilateral deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated patients. In all, one operative death (0.1%) and two brainstem infarctions (0.3%) occurred. Microvascular decompression is a safe and definitive treatment for hemifacial spasm with proven long-term efficacy.

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Contributors

Mustafa AbdelHamid

Journal

Journal ID (nlm-ta): Radiol Case Rep

Journal ID (iso-abbrev): Radiol Case Rep

Title: Radiology Case Reports

Publisher: Elsevier

ISSN (Electronic): 1930-0433

Publication date PMC-release: 23 October 2015

Publication date Collection: December 2015

Publication date (Electronic): 23 October 2015

Volume: 10

Issue: 4

Pages: 65-67

Affiliations

[a ]Department of Cell Biology, University of Virginia, 1340 Jefferson Park Ave, Jordan Hall 2-27, Charlottesville, VA, USA

[b ]Department of Regional Neurosciences, Cleveland Clinic Foundation, Cleveland Clinic Main Campus, Mail Code S30, 9500 Euclid Avenue, Cleveland, OH, USA

[c ]Department of Neuroradiology, University of Virginia, 1215 Lee St, Charlottesville, VA, USA

[d ]Department of Pediatrics, West Virginia University, 3110 Maccorkle Ave SE, Charleston, WV, USA

Author notes

[∗ ] Corresponding author. mma6r@ 123456virginia.edu

Article

Publisher ID: S1930-0433(15)30046-7

DOI: 10.1016/j.radcr.2015.08.006

PMC ID: 4661493

PubMed ID: 26649123

SO-VID: b02c15aa-2a62-4b3a-a59d-c4c622dd0610

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hemifacial spasm due to vertebrobasilar dolichoectasia: a case report

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Most cited references 12

Hemifacial spasm: clinical findings and treatment.

Vertebrobasilar dilatative arteriopathy (dolichoectasia).

Microvascular decompression for hemifacial spasm.

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