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Vascular compression, hemifacial spasm, and multiple cranial neuropathy

Department of Neurology, the Neuromuscular Laboratory, and the Department of Neurosurgery, University of Pittsburgh, PA.

Hemifacial spasm is usually an isolated symptom resulting from facial nerve root compression. Three patients had, in addition, tinnitus, hearing loss, facial sensory loss, diminished gag reflex, dysphagia, and dysarthria. Acoustic reflexes were abnormal, and facial nerve conduction studies showed evidence of ephaptic transmission and ectopic excitation. Brain CT and metrizamide cisternography were normal. Surgical exploration showed compression of cranial nerve roots by posterior inferior cerebellar artery branches. After decompression, symptoms abated, and electrical signs of hemifacial spasm disappeared. Vascular compression of nerve roots in the cerebellopontine recess may cause multiple cranial neuropathy.

Address correspondence and reprint requests to Dr. Eidelman, Department of Neurology, 322 Scaife Hall, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.

Presented in part at the thirty-sixth annual meeting of the American Academy of Neurology, Boston, MA, April 1984.

Accepted for publication September 5, 1984.