ABSTRACT
Hemifacial spasm and blepharospasm are crippling medical conditions that severely affect the quality of life of patients. Among differential diagnosis, the ectasia of vertebro-basilar vessels should be taken into account, and treated accordingly.
Authors report the case of a 60-years old male with a two-year history of involuntary intermittent twitching of the right eye and right side of the upper lip. MRI of the brain suggested a dolichoectasia of the vertebral artery. The condition was almost refractory to drugs and the patient was referred for neurosurgical intervention.
Keywords: hemifacial spasm, blepharospasm, neurovascular conflict
Hemifacial spasm and blepharospasm are subtypes of peripheral movement disorder. They are divided into primary and secondary categories based on their etiology. Primary hemifacial spasm usually follows a neurovascular conflict between the posterior circulation vessels and facial nerve root, while common secondary causes are the Bell’s palsy, traumatic injury of the facial nerve, demyelination, and stroke [1, 2].
A 60 years old Albanian man reported a two-year history of involuntary intermittent twitching of the right eye and right side of the upper lip that came to his attention only recently due to increased frequency. The patient did not report any other medical illnesses, nor a positive family history of involuntary movements. When asked, he denied contractions in other body parts. Unilateral involuntary contractions affecting his right orbicularis oculi and right orbicularis oris were noted during neurological examination. Spasms were isolated in these two muscles and no other objective sign was found.