Diagnosis: Other disorders of facial nerve Unspecified abnormal involuntary movements Occlusion and stenosis of basilar arteryClinical question: Pt with multiple abnormal involuntary movements resembling hemifacial spasm, hemiballismus, tremorSigns and Symptoms: Pt with multiple abnormal involuntary movements resembling hemifacial spasm, hemiballismus, tremor MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The right AICA is duplicated. The right AICA meatal loop is readily identified in the right internal auditory meatus and originates from the superior origin of the right AICA. Together the AICA branches are dominant over the PICA. The left PICA is dominant. There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is no major artery abutting the trigeminal nerves.The anterior communicating artery is identified and is medium size. The left posterior communicating is very small. There is fetal origin of the right PCA. The right P1 segment is tortuous and small. The vertebral arteries are similar in size.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MRI of the brain is within normal limits. No abnormal enhancing mass lesions are appreciated in the brain or skull base to explain hemifacial spasm.4.No arterial loop is identified to explain hemifacial spasm.