LAUSR

Hemifacial spasm is a movement disorder characterised by tonic or clonic contractions of the muscles on one side of the face, which may manifest in short episodes or persistently. Vestibular paroxysmia manifests with recurrent episodes of sensation of movement and instability of less than one minute’s duration; these generally occur several times per day: episodes may or may not be triggered by posture. Both entities are included in the group of neurovascular compression syndromes, caused by vascular compression of the entry/exit site of the cranial nerves, close to the brainstem. Neurovascular compression syndromes include superior oblique myokymia, trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia, which are caused by compression of the fourth, fifth, seventh, eighth, and ninth cranial nerves, respectively. We describe the case of a patient who simultaneously developed hemifacial spasm and vestibular paroxysmia. Our patient is a 37-year-old Colombian woman with migraine with aura as the only relevant history. The patient visited our hospital due to a 3-month history of involuntary movements of the right side of the face and paroxysmal episodes of vertigo. Involuntary movements of the face had persisted since onset. Muscle contractions caused narrowing or closure of the right palpebral fissure and, on occasions, a feeling of tightness of the same side of the face with facial droop. She simultaneously started to develop episodes characterised by a sensation of movement lasting a few seconds and not triggered by posture; episodes presented 5-10 times daily. The patient experienced instability and tinnitus between episodes. The examination revealed tonic contraction of the right orbicularis oculi and lower facial muscles, with occasional clonic movements (Fig. 1). Furthermore, we detected signs of right vestibular hypofunction, with corrective saccades to the right in the head impulse test, and tendency to the right in the pointing test and Romberg test. No other significant findings were observed in the neurological and systemic examinations. A brain magnetic resonance imaging (MRI) scan was performed with a General Electrics HDxt 1.5 Tesla MRI scanner equipped with an 8-channel high-resolution head coil.