Painful tic convulsive as manifestation of vertebrobasilar dolichoectasia

Abstract

A 79-year-old man presented with a one-year history of intense, paroxysmal, left-sided facial pain (V2 and V3 trigeminal division), that felt like an electric shock for a duration of seconds, and four months of involuntary spasms of the left side of the face involving perioral and periocular muscles. An MRI with angiography showed a vertebrobasilar dolichoectasia causing compression of the left V, VII and VIII cranial nerves (Figures 1 A and B, and 2). The combined presentation of hemifacial spasm and ipsilateral trigeminal neuralgia is also known as painful tic convulsive, which is a rare condition commonly associated with vascular compression 1,2,3,4. We report a case secondary to vertebrobasilar dolichoectasia.