Friday, 9 September 2011

Vascular loop syndrome

A  50 y o male with typical left hemi facial spasm.

Routine MRI axial T2w sequences were absolutely normal except tortuous vertebro basilar with marked tortuousity of left sided vertebral.
With history of left hemi facial spasm area of interest was left side 7-8th CN Complex, study repeated with very thin axial sections at the level of IAC, showed tortuous left vertebral artery causing an obvious compression over left 7- 8th CN Complex.
Imaging diagnosis: Vascular loop syndrome with 7th - 8th CN Compression,  Hemifacial spasm. 
video

Vascular loop syndrome

Abnormal anatomical variation or course of vessel causing symptomatic compression over cranial nerves at IAC or Cp Angle cistern.
Spasmodic hyperfunction of nerve due to compression.
Compression of 5th CN (Trigeminal nerve) present with trigeminal neuralgia and 7th CN (Facial nerve) present with hemi facial spasm.
Trigeminal nerve involvement due to vascular loop is more common than Facial nerve.

'Kindling' theory, pulsatile vessel coming in contact with nerve induces ectopic excitations which travel retrogradly back to the Cranial Nerve nucleus.
Routine T2w images used for brain may be insufficient.
High index of suspicion with high resolution T2w sections in the region of posterior fossa are must.
Age of presentation is older age group after 65, though it's anatomical variation or abnormality.

2 comments:

Anonymous said...

I am a 42 year old who has just been diagnosed with this... 16 years ago I was traumatized by a tripod blowout fracture in and around the left orbital from bein pistol whipped nearly half to death-within past month I have been having "charlie horse" type cramps from my neck to eye and severe twitching around eye cheek and lip. Wondering how this is cured......ken. philly

Anonymous said...

I am a 42 year old who has just been diagnosed with this... 16 years ago I was traumatized by a tripod blowout fracture in and around the left orbital from bein pistol whipped nearly half to death-within past month I have been having "charlie horse" type cramps from my neck to eye and severe twitching around eye cheek and lip. Wondering how this is cured......ken. philly