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Sometimes small blood vessels can be compressed and cause symptoms of dizziness, facial spasm or facial pain, depending on which vessel is affected. These vessels are seen on the surface of the brain, near the affected nerve as it exits the brain and with each pulsation, the vessel “rubs” the nerve and over time alters the signal response of the nerve. Diagnosis requires a battery of tests, including imaging studies (MRI/MRA), balance testing (ENG/VNG), comprehensive hearing testing (audiometry) and ABR. The most definitive treatment is surgery, in which the offending vessel is rotated away from the affected nerve. A small piece of Teflon material is interposed between the vessel and nerve to prevent the vessel from coming into contact with the vessel again. Vascular compression associated with the ear and skull base are hemifacial spasm, trigeminal neuralgia and vertebral artery compression.
Hemifacial spasm
Hemifacial spasm is an uncommon disease in which there are frequent, painless and involuntary or spasmodic contractions of the face on one side. The contractions often start at the eye and progress to the entire side of the face. This is thought to be related to an abnormal compression of the facial nerve by a blood vessel (usually the anterior inferior cerebellar artery or a branch of this vessel). Since the majority of the facial nerve is a motor nerve, as it is constantly “rubbed” it results in spasmodic contraction of the facial musculature. Treatments include medication, injections of Botox and surgical manipulation of the nerve from the blood vessel.
Trigeminal neuralgia (Tic Doulourex)
Trigeminal neuralgiais a disorder characterized by sharp stabbing pain on one side of the face. It is related to an artery (usually the superior cerebellar artery or a branch of this vessel) compressing the trigeminal nerve, which results in the facial pain on one side of the face. The trigeminal nerve is responsible for sending impulses to the brain about touch and pressure from the forehead, jaw, gums and area around the eyes. Since the majority of this nerve is a sensory nerve, as the nerve is “rubbed” it causes the sensation of severe facial pain. It may be very intense when present but there is no dysfunction of the muscles of the face. The pain often lasts for several seconds, and sometimes recurs one after another. Pain is usually triggered by touching the face, brushing the teeth, smiling, eating, or moving the mouth with talking. Trigeminal neuralgia is found more in women than men. A majority of individuals affected are over 50 years of age. Medications are prescribed initially, but if they cannot be taken because of adverse side effects, or they are not effective in controlling the symptoms, surgery is an option. Back to Top
Vertebral artery compression
The vertebral artery travels through the bones in the neck and supplies circulation to the back of the brain and brainstem. Rarely, extra movement between the vertebrae and or bone spurs can press on the artery when moving the head or neck. Vertebral artery compression as described above can cause dizziness, nausea, lightheadedness or even fainting. Treatment requires surgery to remove the offending bone that compresses the artery.