Abstract
A 45-year-old male presented to the ophthalmology clinic complaining of constant twitching in the left face for three years, associated with a moderate left temporal headache. He was noted to have tonic-clonic contractions of the left orbicularis oculi and oris muscles (Figure 1, Video 1). MR imaging through the posterior fossa (Figure 2) demonstrated compression of the pons at the facial nerve root entry zone by an ectatic left vertebral artery. The patient’s symptoms improved with botulinum neurotoxin injections. The most common etiology of hemifacial spasm is compression of the facial nerve as it emerges from the brainstem by ectatic vessels.
Highlights
A 45-year-old male presented to the ophthalmology clinic complaining of constant twitching in the left face for three years, associated with a moderate left temporal headache
The compression of the facial nerve can be caused by tumors or bony abnormalities, compression by a blood vessel is the most common [2]
Botulinum toxin injection is clinically successful for long term management with low incidence of adverse effects [4]
Summary
A 45-year-old male presented to the ophthalmology clinic complaining of constant twitching in the left face for three years, associated with a moderate left temporal headache. He was noted to have tonic-clonic contractions of the left orbicularis oculi and oris muscles (Figure 1, Video 1). MR imaging through the posterior fossa (Figure 2) demonstrated compression of the pons at the facial nerve root entry zone by an ectatic left vertebral artery. The patient’s symptoms improved with botulinum neurotoxin injections. The most common etiology of hemifacial spasm is compression of the facial nerve as it emerges from the brainstem by ectatic vessels
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