Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm

Han, Jingzhe; Wang, Tingting; Xie, Yanling; Cao, Duantao; Kang, Zhilei; Song, Xueqin

doi:10.1097/md.0000000000011192

Cited by 12 publications

(11 citation statements)

References 17 publications

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“…The symptoms are triggered by ephaptic transmission between demyelinated axons due to the pulsatile compression of the responsible vessel [19,23]. A loop of the AICA seems to be the most relevant vessel (77.8-100%), followed by the posterior inferior cerebellar artery (PICA), the vertebral artery and veins [8,10,26]. Radiology is essential for a clear view of neurovascular contact, but the pressure of the vessels on nerves cannot be confirmed only by imaging.…”

Section: Discussionmentioning

confidence: 99%

Application of ABR in pathogenic neurovascular compression of the 8th cranial nerve in vestibular paroxysmia

et al. 2022

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Purpose To investigate the clinical value of electrophysiological tests in indicating pathogenic vascular contact of the 8th nerve in definite vestibular paroxysmia (VP) cases to provide a reference for decompression surgery. Methods We retrospectively analyzed patients who had vertigo, unilateral tinnitus, or hearing loss and exhibited vascular contact of the 8th cranial nerve by MRI. Participants were classified into the VP or non-VP group according to the criteria of the Bárány Society in 2016. The demographic characteristics and audiological and electrophysiological test results of the two groups were compared. Receiver operating characteristic (ROC) curves were calculated for ABR to determine the best parameters and cutoff values to predict the existence of pathological neurovascular contact in VP. Results Thirteen patients in the VP group and 66 patients in the non-VP group were included. VP patients had longer interpeak latency (IPL) I–III and wave III latency compared to non-VP patients (p < 0.001; p < 0.001). According to the ROC analyses, IPL I–III and wave III latency were the best indicators for the diagnosis of VP. The optimal cutoff for IPL I–III was 2.3 ms (sensitivity 84.6%, specificity 95.5%), and that for wave III latency was 4.0 ms (sensitivity 92.3%, specificity 77.3%). There were no differences in the PTA, caloric test, o-VEMP, or c-VEMP results between the two groups. Conclusion Prolonged IPL I–III and the wave III latency of ABR strongly suggested that vascular contact of the 8th cranial nerve was pathological, which may provide some references for microvascular decompression surgery of VP.

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Section: Discussionmentioning

confidence: 99%

Application of ABR in pathogenic neurovascular compression of the 8th cranial nerve in vestibular paroxysmia

et al. 2022

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“…For instance, there are patients who have, in addition to recurrent episodes of vertigo, other neurological symptoms and signs such as facial hemispasm ( 8 , 9 ) due to combined irritation of cranial nerves VIII and VII in the meatus acusticus internus where both nerves lie close to each other. There is also a description of the combination of trigeminal neuralgia and facial hemispasm ( 10 ).…”

Section: Discussion/conclusionmentioning

confidence: 99%

Case report: Bitter vertigo

Goldschagg

Brem²,

Strupp³

2022

Front. Neurol.

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BackgroundThere are many causes of episodes of vertigo and very few causes of episodes of changes in taste, and the combination of the two is very rare. Here, we describe a patient with recurrent short episodes of vertigo in combination with simultaneous episodes of recurrent paroxysmal dysgeusia and altered feeling on the left side of face. The symptoms were caused by compression of the vestibulocochlear nerve and the facial nerve due to dolichoectasia of the basilar artery.MethodsThe patient was diagnosed in our routine clinical practice and underwent a complete neurological and neuro-otological examination, including video head impulse test, caloric irrigation, ocular and cervical vestibular evoked myogenic potentials, acoustic-evoked potentials, neuro-orthoptic examination, cranial MRI, and MR angiography. The patient was seen twice for follow-up.CaseA 71-year-old patient primarily presented with a 2-year history of recurrent short episodes of spinning vertigo. Each of the episodes began with an altered feeling on the left side of the face, followed by a bitter taste on the left half of the tongue, and subsequently vertigo lasting for up to 15 s. The frequency of the attacks was high: up to 80 times per day. Laboratory tests revealed signs of a peripheral vestibular deficit on the left side. There were no signs of sensory or motor deficits or of altered taste between the episodes. An MRI of the brain showed an elongated basilar artery leading to an indentation of the facial and vestibulocochlear nerves on the left side.ConclusionWe propose a neurovascular compression in the proximal part of two cranial nerves because of pulsatile compression by the elongated basilar artery with ephatic discharges as the cause of the recurrent episodes. Consistent with the theory of ephatic discharges, treatment with the sodium channel blocker lacosamide for over six months with a final dosage of 200 mg per day p.o. led to a significant reduction of the attack frequency and intensity. This treatment option with a sodium channel blocker should therefore not only be considered in vestibular paroxysmia but also in cases of paroxysmal dysgeusia.

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“…Angiography is considered the gold standard for diagnosing vertebro-basilar dolichoectasia, on the other hand, MRI was cited as the exam of choice in most services, due to the possibility of better assessing the relationship between vascular structures and brains tissues. 14 BERA can also be considered for investigation of asymetric hearing loss associeted with basilar dolichoectasia. 2 Adequate treatmente for the condition under discussion remains a dilema.…”

Section: Discussionmentioning

confidence: 99%

Basilar dolichoectasia with otorhinolaryngological symptoms: A case report

Martins¹,

Silva

Artigoza

et al. 2021

BJHBS

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Introduction: Basilar dolicoectasis is an uncommon change,which makes the vessel tortuous and dilated, which can leadto ischemic, hemorrhagic or compressive changes. Objective:The present study is case report of a patient with basilar arterydolicoectasis and otorhinolaryngological symptoms. ClinicalCase: Patient, 53 years old, male, smoker, hypertensive, atrialfibrillation and gout, who after hospitalization due to strokesuffered a complaint of hearing loss, facial paralysis and dizziness.During hospitalization, he was diagnosed with basilarartery dolichoectasia. Conclusion: Basilar artery dolichoectasiais rare, the otorhinolaryngologist should be aware of vascularcauses when evaluating a patient with otoneurological symptoms.The treatment of basilar artery dolichoectasis remainscontroversial.

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Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm

Cited by 12 publications

References 17 publications

Application of ABR in pathogenic neurovascular compression of the 8th cranial nerve in vestibular paroxysmia

Application of ABR in pathogenic neurovascular compression of the 8th cranial nerve in vestibular paroxysmia

Case report: Bitter vertigo

Basilar dolichoectasia with otorhinolaryngological symptoms: A case report

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