Hemifacial Spasm and Pontine Compression Caused by a Giant Vertebrobasilar Dolichoectasia

rant artery or cerebellopontine angle masses [2, 3] . The offending vessels are usually arterial structures, such as the anterior or posterior inferior cerebellar arteries [4] . We present the case of a patient with HFS secondary to compression by a giant vertebrobasilar dolichoectasia (VBD) and highlight the possible association of HFS with VBD and type 1 neurofibromatosis (NF-1). A 70-year-old man complained of a 3-year history of intermittent, involuntary muscle spasms involving the left lower and mid portions of his face. Approximately 18 months before presentation, he gradually developed mild speech difficulties that progressed to moderate dysarthria with nasality without diurnal variation or ocular symptoms. His past medical history was significant for NF-1 and renal cell carcinoma (postnephrectomy) and was negative for hypertension or hyperlipidemia. Physical examination revealed multiple cutaneous neurofibromas and cafe au lait spots, with axillary freckling, confirming the diagnosis of NF-1 ( fig. 1 D). Neurological examination revealed intermittent spasms of the midand lower-left facial region consistent with left HFS. Mild dysarthria with nasality were also noted. The rest of the examination was otherwise normal. Plantar reflexes were flexors. Hemifacial spasm (HFS), characterized by irregular, involuntary and recurrent tonic and clonic contractions of muscles innervated by the ipsilateral facial nerve [1] , is usually attributed to compression of the facial nerve at the root entry zone by an aberPublished online: March 18, 2009