Independent episodes of vestibular paroxysmia and hemifacial spasm duo to a distorted vertebral artery in one patient

A 56-year-old woman presented with a 3-year history of paroxysmal right facial spasms and 1-year paroxysmal episodes of vertigo. The episodes of vertigo and hemifacial spasm were not interdependent, neither simultaneous nor sequential. She failed conservative medical management including flunarizine, topiramate, and betahistine mesilate in the local hospital. After admission to our hospital, magnetic resonance imaging (MRI) was ordered and found the tortuosity of the vertebrobasilar arterial system, which presented the lateral shift of the vertebrobasilar junction. The distorted right vertebral artery compresses and dislocates ipsilateral facial nerve and cochleovestibular nerve, compatible with neurovascular conflict (Fig. 1). Carbamazepine was given and the symptoms were just slightly relieved. The patient underwent microvascular decompression (MVD) using Teflon felt to separate the responsible vertebral artery from the two cranial nerves with complete relief of symptoms. After 2 years of follow-up, hemifacial spasm or vestibular symptoms rarely occurred. MRI was re-examined and showed an enlarged space between facial nerve and cochleovestibular nerve and vertebral artery, separated by Teflon felt (Sup Fig. 1).

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