Teaching Video NeuroImage: Bilateral Hemifacial Spasm and Left Glossopharyngeal Neuralgia Caused by Bilateral Vertebral Artery Displacement

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 bilateral hemifacial spasm 1 (Video 1).Brain MRI and time-of-flight angiogram revealed tortuous vertebral Figure Imaging Axial T2-3D-DRIVE MRI reveals compression of bilateral cranial nerves VII (red arrows) (A: right side; B: left side) and IX (C) (yellow arrows) by the vertebral arteries (red asterisks).Time-of-flight MR angiogram with maximum intensity projection (D) highlights the arched bilateral vertebral arteries (red arrows) compressing the bilateral cerebellopontine angle.