Routine
biochemical tests and cell blood count were normal. Magnetic Resonance
Imaging showed the neurovascular conflict between the right facial nerve
and right dolichoectasia of the vertebral artery (Figure
1) . The neurosurgical team recommended microvascular decompression
surgery of the facial nerve as a definitive treatment.
Figure 1 (composed): Left and middle inset : axial
MRI images, plain and contrast-phase (angio) showing the dilated,
ectatic right vertebral artery in close contact with brainstem
structures. Right inset: angio-MRI imaging of the vessel
tortuosity, right vertebral artery.
The patient refused it and preferred pharmacological treatment. We
decided to start the treatment with Clonazepam 2 mg per day. The patient
came after several months without any clinical improvement. During these
follow-up visits, the neurological examination remained unchanged.
Treatment with Baclofen 40 mg per day was started, without any
improvement. The patient decided to undergo surgery after unsuccessful
pharmacological treatment. The spasms resolved the next postoperative
day, without recurrence after a one-year follow-up.
Dolichoectasia of the
vertebro-basilar system is a
normal anatomic variant, where the arteries are enlarged and tortuous.
It is usually not associated with neurological complications. Some cases
have reported manifestations of dolichoectasia of vertebro-basilar
system with hydrocephaly, bulbar compression, and vestibulocochlear
symptoms [3]. In most cases, primary hemifacial spasms and
blepharospasm relate to a neurovascular conflict of the anterior
inferior cerebellar artery and posterior inferior cerebellar artery,
while our patient’s symptoms were caused by dolichoectasia of the
vertebral artery. Herewith we emphasize the importance of surgical
treatment as a permanent solution to this condition.