Posterior Fossa AVM Producing Hemifacial Spasm: A Case Report

Abstract

Hemifacial spasm is a disorder characterized by intermittent, chronic, unilateral contractions of the facial musculature. Although hemifacial spasm has been recognized as a diagnostic entity, the basic pathophysiology of this syndrome is not established. The association of hemifacial spasm with a vascular lesion (of the basilar artery) compressing the seventh nerve was first recorded 100 years ago.' Since then, several authors have observed vascular abnormalities close to the intracranial seventh nerve in patients with hemifacial spasm.2-4 More recently, Jannetta,5-7 with the aid of the operating microscope, observed arterial compression or distortion of the proximal seventh nerve in over 70 cases of hemifacial spasm. We are reporting a case of hemifacial spasm in a young patient with a posterior fossa arteriovenous malformation. Case ReportA 24-year-old man was admitted to the Oakland Veterans Administration Hospital in June 1974 with complaints of occipital headaches, unsteady gait, and difficulties with coordination. He had had these complaints for 18 months. The patient had also been troubled by frequent twitching movements of the entire left side of his face for the 6 months preceding admission. These hemifacial spasms had first started around the left eye and corner of the mouth, had occurred several times daily, and lasted for varying periods-from minutes to hours.General physical examination was normal, and mental status testing revealed the patient to be alert and fully oriented. The optic fundi were benign, and the pupillary responses were normal. The patient commanded a full range of extraocular movements, although there was increased end-point nystagmus with left lateral gaze. Hypesthesia affected all three divisions of the left fifth nerve, and the left corneal response was also diminished.There were three rhythmic contractions of the left orbicularis oris every second, and the eye was in effect closed. There was also very mild lower left facial weakness. Nystagmus responses to caloric irrigation were markedly reduced bilaterally and there was no facilitation of the caloric-induced nystagmus with occular fixation. No other abnormal cranial abnormalities were detected.Motor testing revealed a definite left hemiparesis, predominant in the lower extremity.at University of British Columbia Library on June 25, 2015 ang.sagepub.com Downloaded from

Hemifacial Spasm: Results of Microvascular Relocation

“…Many authors have reported the association of hemifacia spasm and compressive lesions in the cerebello-pontine angl (Cushing, 1917;Dandy, 1934;Ehni, 1945;Campbell, 1947Gardner, 1962Fabinyi, 1978;Davis, 1981). Similarily Maroo (1978), Pierry (1979), Shih (1981 and Dujovny (1979) have indicated large arterio-venous mal formations or aneurysms are associated with hemifacial spasm Subsequent to our initial series, we have had one case cause by an epidermoid cyst in the CP angle. Gardner and Sav (1962) were the first to report a significant number of surgica cases where the 7th nerve was compressed by an obviou pathologic process or a redundant vessel in the cerebello pontine angle.…”

Hemifacial Spasm: Results of Microvascular Relocation

“…Many authors have reported the association of hemifacia spasm and compressive lesions in the cerebello-pontine angl (Cushing, 1917;Dandy, 1934;Ehni, 1945;Campbell, 1947Gardner, 1962Fabinyi, 1978;Davis, 1981). Similarily Maroo (1978), Pierry (1979), Shih (1981 and Dujovny (1979) have indicated large arterio-venous mal formations or aneurysms are associated with hemifacial spasm Subsequent to our initial series, we have had one case cause by an epidermoid cyst in the CP angle. Gardner and Sav (1962) were the first to report a significant number of surgica cases where the 7th nerve was compressed by an obviou pathologic process or a redundant vessel in the cerebello pontine angle.…”

Plasticity of the Extracranial Facial Nerve

“…Fasciculations have been reported in a variety of conditions producing facial nerve compression or irritation 36‐40 . Injured nerves often show ephaptic “cross‐talk” between damaged nerve fibers during and following ischemia 41‐51 .…”

Hemifacial Spasm: Results of Microvascular Relocation

“…Many authors have reported the association of hemifacia spasm and compressive lesions in the cerebello-pontine angl (Cushing, 1917;Dandy, 1934;Ehni, 1945;Campbell, 1947Gardner, 1962Fabinyi, 1978;Davis, 1981). Similarily Maroo (1978), Pierry (1979), Shih (1981 and Dujovny (1979) have indicated large arterio-venous mal formations or aneurysms are associated with hemifacial spasm Subsequent to our initial series, we have had one case cause by an epidermoid cyst in the CP angle. Gardner and Sav (1962) were the first to report a significant number of surgica cases where the 7th nerve was compressed by an obviou pathologic process or a redundant vessel in the cerebello pontine angle.…”

Plasticity of the Extracranial Facial Nerve

“…Fasciculations have been reported in a variety of conditions producing facial nerve compression or irritation 36‐40 . Injured nerves often show ephaptic “cross‐talk” between damaged nerve fibers during and following ischemia 41‐51 .…”

Hemifacial Spasm: Results of Microvascular Relocation

“…Many authors have reported the association of hemifacia spasm and compressive lesions in the cerebello-pontine angl (Cushing, 1917;Dandy, 1934;Ehni, 1945;Campbell, 1947Gardner, 1962Fabinyi, 1978;Davis, 1981). Similarily Maroo (1978), Pierry (1979), Shih (1981 and Dujovny (1979) have indicated large arterio-venous mal formations or aneurysms are associated with hemifacial spasm Subsequent to our initial series, we have had one case cause by an epidermoid cyst in the CP angle. Gardner and Sav (1962) were the first to report a significant number of surgica cases where the 7th nerve was compressed by an obviou pathologic process or a redundant vessel in the cerebello pontine angle.…”

Plasticity of the Extracranial Facial Nerve

“…Fasciculations have been reported in a variety of conditions producing facial nerve compression or irritation 36‐40 . Injured nerves often show ephaptic “cross‐talk” between damaged nerve fibers during and following ischemia 41‐51 .…”