Objective: To evaluate the clinical characteristics and neuroimaging findings observed in the association between hemifacial spasms (HFS) and other cranial neuropathy in a cohort of patients with HFS.

Background: HFS is characterized by irregular clonic or dystonic movements of muscles innervated by the ipsilateral facial nerve and usually attributed to neurovascular compression of the facial nerve by the vertebrobasilar dolichoectasia (VBD), an anatomical variation of the vertebrobasilar system involving arterial enlargement and dilatation, often associated with tortuosity and elongations. Moreover, HFS is occasionally accompanied by other symptoms, such as trigeminal neuralgia, facial numbness, auditory disturbances, vertiginous symptoms, visual problems, or bulbar dysfunction.

Methods: We examined 136 patients clinically diagnosed with HFS at movement disorder center in a tertiary referral hospital. VBD was diagnosed according to previously reported MRI protocols. (1) For neuroradiologic evaluation of VBD, the basilar artery (BA) diameter was measured at the midpons level on MRA maximum projection imaging or source imaging. The height of the BA bifurcation and the lateral displacement of the BA were graded according to the scale of Smoker et al. (2). The clinical (demographics data, clinical manifestations, and associated medical conditions) and neuroimaging findings of patients with or without other cranial neuropathy were compared.

Results: Of 136 HFS patients, 45 patients had documented with associated cranial neuropathy (36 episodic ear clicks or tinnitus, 21 vestibular paroxysmal symptoms, 6 associated trigeminal neuralgia, 2 eye movement problems, 2 bulbar symptoms, 1 episodic fainting). Patients with isolated HFS and those with multiple cranial neuropathy showed no difference in age, proportion of sex, disease duration, prevalence of diabetes mellitus, hypertension and previous stroke. The group with associated cranial neuropathy revealed the significant increment in mean BA diameter and BA lateral displacement. Otherwise, there was no significant difference in BA height for the two groups.

Conclusions: The association with other cranial neuropathy in HFS patients is not uncommon. Our clinicoradiologic analyses also suggest good correlation between the existence of associated cranial neuropathy and the extent and severity of neurovascular compression in HFS patients.

References: 1. Wolfe T, et al. J Stroke Cerebrovasc Dis 2008;17:388-393.
2. Smoker WR, et al. AJNR Am J Neuroradiol 1986;7:55-60.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-clinical-and-neuroimaging-analysis-in-hemifacial-spasm-with-associated-cranial-neuropathy-retrospective-case-series-study/