Hemifacial Spasm caused by a Dolicho-ectatic Basilar Artery

An otherwise healthy man presented with left hemifacial spasm of 3 years duration. It started with left blepharospasm (involuntary contractions of eyelid muscles) causing narrowing of palpebral aperture. Gradually, the symptoms progressed to involve the left side of face. Involuntary contractions occurred in muscles of facial expression and lip muscles also.

T2W MRI Axial image showing a dolichoectatic basilar artery compressing the left facial nerve
T2W MRI Coronal image showing a dolichoectatic basilar artery compressing the left facial n

MRI with MR Angiogram was done to investigate any underlying cause of left hemifacial spasm. MRI showed a dolicho-ectatic tortuous basilar artery, which was compressing the left facial nerve at its exit point from pons.

In a large series of patients with hemifacial spasm, 15% of patients were found to have vertebro-basilar artery dolichoectasia compressing the facial nerve. On the other hand, only 3% of patients without hemifacial spasm had vertebro-basilar dolichoectasia.

Other secondary causes of hemifacial spasm include tumors, stroke, multiple sclerosis, trauma, etc.

Treatment in this condition is surgical decompression of the facial nerve. Botox injections can also help, however, it would need to be taken once in 3 months for a long period. Medicines helpful in ameliorating the symptoms of hemifacial spasm include carbamazepine and clonazepam.

Conclusion: An effort should be made to determine the underlying secondary cause of hemifacial spasm, which can help in selecting the best treatment modality.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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