Bilateral painful tic convulsif

Abstract

SUMMARY'Painful tic convulsif' (PTC) describes the co-existence of hemi-facial spasm and trigeminal neuralgia. In this report, we describe a unique presentation of bilateral PTC in a gentleman with bilateral hemi-facial spasm and trigeminal neuralgia secondary to neurovascular conflict of all four cranial nerves. Following failed medical and radiofrequency therapy, microvascular decompression of three of the four involved nerves was performed, where the offending vessels were mobilised and Teflon used to prevent conflict recurrence. He continues to respond to Botox for right hemi-facial spasm. Since surgery he remains pain-free bilaterally and spasmfree on the left.

Aberrant Abducent Nerve During Microvascular Decompression for Trigeminal Neuralgia

“…Microvascular decompression (MVD) of cranial nerves is a commonly performed neurosurgical procedures for diverse conditions that include trigeminal neuralgia and hemifacial spasm. 1,2,3,4 A good clinical outcome requires transposition of the offending vessel away from the relevant cranial nerve without damage to nearby structures. Here, we report a case of a severely distorted abducent nerve, stretched around an arterial loop, noted incidentally during MVD for trigeminal neuralgia.…”