Bilateral painful tic convulsif

BMJ Case Rep. 2017 Aug 11:2017:bcr2017221380. doi: 10.1136/bcr-2017-221380.

Abstract

'Painful tic convulsif' (PTC) describes the coexistence of hemifacial spasm and trigeminal neuralgia. In this report, we describe a unique presentation of bilateral PTC in a man with bilateral hemifacial spasm and trigeminal neuralgia secondary to neurovascular conflict of all four cranial nerves. Following failed medical and radiofrequency therapy, microvascular decompression of three of the four involved nerves was performed, where the offending vessels were mobilised and Teflon used to prevent conflict recurrence. He continues to respond to Botox for right hemifacial spasm. Since surgery, he remains pain free bilaterally and spasm free on the left.

Keywords: cranial nerves; neuroimaging; neurosurgery; pain (neurology).

Publication types

  • Case Reports

MeSH terms

  • Acetylcholine Release Inhibitors / therapeutic use*
  • Aged
  • Botulinum Toxins, Type A / therapeutic use*
  • Cranial Nerves / physiopathology*
  • Disease Progression
  • Hemifacial Spasm / etiology
  • Hemifacial Spasm / physiopathology*
  • Hemifacial Spasm / therapy
  • Humans
  • Male
  • Microvascular Decompression Surgery / methods*
  • Tics / etiology
  • Tics / physiopathology*
  • Tics / therapy
  • Treatment Outcome
  • Trigeminal Neuralgia / complications
  • Trigeminal Neuralgia / physiopathology*
  • Trigeminal Neuralgia / therapy

Substances

  • Acetylcholine Release Inhibitors
  • Botulinum Toxins, Type A