ABSTRACT
Simultaneous hemifacial spasm (HFS) and trigeminal neuralgia caused by cranial nerve (CN) compression from a tortuous basilar artery (BA) is very rare. We report a case of a 66-year-old man who presented with both HFS and "atypical" trigeminal neuralgia. The patient had a tortuous BA compressing both CN V and VII. The patient underwent microvascular decompression after failing conservative medical management. To the best of our knowledge this is the first reported case of both HFS and "atypical" trigeminal neuralgia that were both successfully treated by surgical intervention. We report the management of this rare combination and review the literature.
Subject(s)
Abducens Nerve/surgery , Basilar Artery/surgery , Hemifacial Spasm/surgery , Neuralgia/surgery , Trigeminal Nerve/surgery , Trigeminal Neuralgia/surgery , Aged , Basilar Artery/pathology , Decompression, Surgical , Humans , Male , Microvascular Decompression Surgery , Nerve Compression Syndromes/surgery , Treatment OutcomeABSTRACT
Peripheral nerve injuries are caused by traction, laceration and missile injury. Primary surgical repair is recommended for clean, sharp injuries that cause transection of a nerve. In compressed, stretched or contused nerves, surgical repair at three months is indicated if functional recovery has not occurred. Electromyography and nerve conduction studies are helpful in deciding which patients need secondary repair. Recovery is possible for 18 months following injury. Since nerve regeneration occurs at a rate of one inch per month, the distance from the nerve injury to the innervated muscle must be less than 18 inches. Therefore, the outcome is generally better in distal lesions than in proximal ones.
Subject(s)
Peripheral Nerve Injuries , Action Potentials , Female , Humans , Male , Nerve Regeneration/physiology , Neurophysiology , Peripheral Nerves/anatomy & histology , Peripheral Nerves/physiology , Peripheral Nerves/surgery , PrognosisABSTRACT
We have described a patient with neurogenic hyperthermia caused by a diencephalic infarction. His hypothalamic dysfunction was a consequence of cerebral vasospasm from aneurysmal subarachnoid hemorrhage. Persistent elevation of body temperature did not respond to standard therapy, but successful treatment was achieved with cyproheptadine and indomethacin, presumably through antagonism of serotonin and prostaglandin activity.