CASE PRESENTATION

2010-04-16 R3

CASE
10223881 M/48
C.C: Lt hemifacial spasm for 10 days

Hemifacial spasm due to Vascular Compression of facial N.

Hemifacial spasm Sx complex of hyperactive dysfunction of unilateral facial nerve

Spontaneous onset of intermittent twitching in orbicularis oculi muscle spreads downward to include all facial muscle including platysma
40-50 years old age

Hemifacial spasm due to Vascular Compression of facial N . Mechanism of hemifacial spasm

Vascular compression of facial nerve at root exit zone (central myelin changes to peripheral myelin)
Role of neuroradiologic studies
Not only to exclude other causes but also to detect vascular structures adjacent to N. root

Hemifacial spasm due to Vascular Compression of facial N

MR criteria
Compressive vessels : - Should run at right angles to nerve - Contact at root exit zone & deform root Direction of compression: ventrocaudal

Assess the diagnostic accuracy of 3D MR images in preop. evaluation of hemifacial spasm

27 patients, surgically confirmed Sensitivity 95%, specificity 77%

Radiology 1995; 197:227-231

Left hernifacial spasm caused by compression by AICA

Left hemifacial spasm caused by compression by PICA

REFERENCE
Hemifacial spasm and involuntary facial movements Radiology 1995; 197:227-231 Hemifacial Spasm : Three-dimensional MR Images in Evaluation of Neurovascular Compression

Radiology 1995; 197:227-231