Teaching Video NeuroImage: Bilateral Hemifacial Spasm and Left Glossopharyngeal Neuralgia Caused by Bilateral Vertebral Artery Displacement | Neurology
A 63-year-old otherwise healthy woman developed left-sided facial spasm and glossopharyngeal neuralgia 14 and 8 years ago, respectively, followed by right-sided facial spasm 1 year before evaluation. Her glossopharyngeal symptoms worsened despite treatment with carbamazepine. Neurologic examination was significant for asynchronous bilater al hemifacial spasm 1 (Video 1). Brain MRI and time-of-flight angiogram revealed tortuous vertebral arteries compressing the bilateral facial and glossopharyngeal