Painful tic convulsif.

Abstract

Subsequently, Gardner (1968) reported 11 patients with the syndrome, all of whom had documented posterior fossa lesions (cirsoid aneurysms, arteriovenous malformations, and cholesteatomas). Maurice-Williams (1973) has re-emphasised that the coexistence of trigeminal neuralgia and hemifacial spasm signals the presence of a posterior fossa lesion.We recently examined a patient with painful tic convulsif and vertebrobasilar ectasia and, in consequence, undertook a systematic review of the literature. We discovered that less than half of the 41 reported cases provide sufficient clinical data for analysis and that only 10 patients with painful tic convulsif have been subjected to angiography, surgery, or postmortem examination. Moreover, although the signs and symptoms of patients suffering from it have been described, no attempt has yet been made to define the clinical syndrome or to discuss its diagnosis or the results of treatment. Accepted 19 October 1976 Case report A 67 year old woman was admitted to The New York Hospital with a five years' history of paroxysmal lancinating pain over the right jaw, radiating posteriorly to the ear. Paroxysms of pain were triggered by talking, chewing, or palpating the skin over the ramus of the right mandible; spontaneous paroxysms also occurred. Approximately two years after the onset of right-sided facial pain, she became aware of twitching in the right periorbital muscles, which spread during the ensuing months to involve the majority of the muscles innervated by the right facial nerve. These hemifacial spasms occurred without warning, could not be controlled by conscious effort, and were exacerbated by anxiety. There was no temporal relation between her rightsided facial pain and the attacks of facial hemispasm.The patient complained of mild bilateral hearing loss but denied tinnitus or vertigo. There was no history of headache, visual symptoms, facial paralysis, dysphagia, dysarthria, limb weakness, incoordination, sensory disturbance, or gait disorder.The general medical examination was unremarkable. Neurological examination revealed a right facial contracture (Fig. la) and spasmodic, irregular mass contractions of the right facial muscles, including the orbicularis oculi, levator anguli oris, and platysma. Both corneal reflexes were intact, and facial sensation was normal. Mild bilateral sensorineural deafness was confirmed by audiometry; Hallpike differential caloric tests were normal.

Arachnoid cyst associated with painful tic convulsif

“…2 Campbell and Keedy first drew attention to a possible common aetiology for this entity. 1,3 The lesions responsible for PTC are mainly vascular, ectasia of the vertebral or basilar arteries being the most common. Less frequent causes include disseminated sclerosis, arteriovenous malformation, and cholesteatoma which compress the trigeminal and facial nerve roots in the posterior fossa.…”

“…Vascular compression of root entry zones of the cranial nerves (CN) V and VII is the most common cause of this clinical syndrome. [1][2][3] Tumors have also been reported to result in PTC. [4][5][6][7] We report a patient with an arachnoid cyst of the posterior fossa causing PTC.…”

Painful tic convulsif syndrome due to vertebrobasilar dolichoectasia

“…A variety of medical treatments have been tried in the past, which include diphenylhydantoin, carbamazepine, ethanol injection of gasserian ganglion for trigeminal neuralgia, and saline neurolysis of facial nerve for hemifacial spasms. [ 7 ] More recently, microsurgical decompression techniques have been successfully employed. [ 8 ]…”

Tentorial meningioma and painful tic convulsif

“…The majority of reported cases of painful tic convulsif have had vascular abnormalities around the fifth and seventh cranial nerves, such as ectatic vertebral or basilar arteries, arteriovenous malformations, and angiomas. 1,[4][5][6][7]11,12,15 Tumors causing painful tic convulsif are extremely rare, with only eight cases reported until now (Table 1). In these cases, seven patients had epidermoid cysts and only two, including our case, had meningiomas.…”