Painful spasms in facial, masticatory, and motor ocular muscles reversed after microvascular decompression of a neurovascular conflict at brainstem.

The authors present a case of a 42-year-old female admitted for disabling complex and atypical bilateral facial spasms associated with painful masticatory and motor ocular dystonic movements, difficult to fit in the definition of any known cranio-facial dyskinesias. MRI showed a left PICA loop invaginated into the brainstem, considered responsible of an hyperactive disorder of the brainstem nuclei neighboring the conflict. After microvascular decompression, the patient made a full recovery with complete disappearance of the paroxystic phenomena. Such a type of image should be searched for, in an intra-axial brainstem location, in the absence of conflict in the cistern at root entry/exit zone (REZ).