2026 Poster Presentations
P101: NEUROVASCULAR COMPRESSION SYNDROMES - HEMI-PHARYNGEAL SPASM, A NEW ENTITY?
Taimur Khan1; Fernando Vale-Enrique2; Matthew Lee, MD2; Christopher Carr, MD2; Fernando Vale, MD2; M. Salman Ali, MD2; 1University of California, San Diego; 2Medical College of Georgia at Augusta University
Introduction: Neurovascular compression of Vagus Nerve (VN) is rare. Common symptoms associated with VN compression include hiccups, cough, and symptoms of laryngeal contraction such as stridor. To our knowledge, isolated symptoms of swallowing induced hemi-pharyngeal spasm (HPS) have not yet been reported in relation to VN compression. Here, we present a case report of a rare case of dual compression of Vagus and Facial nerves resulting in hemi-pharyngeal and hemi-facial spasm, respectively.
Methods: A patient with unilateral contractions in the neck/throat and face is reviewed.
Results: A 65yr old female was initially diagnosed with hemifacial spasm (HFS) 5 years ago. She received multiple Botox injections in her face without significant long-lasting improvement in her symptoms. 2 years ago, she developed unilateral contractions in her neck/throat with swallowing. These were ipsilateral to her HFS. These symptoms progressively worsened. These were only triggered by swallowing and lasted a few minutes. There was no associated sharp pain, stridor or dysphonia. She remained asymptomatic in between her episodes. These symptoms were ignored by treating physicians while the focus of treatment remained on HFS. She was eventually referred to our clinic for further evaluation. After carefully reviewing her symptoms and detailed imaging, a loop of posterior inferior cerebellar artery (PICA) was identified compressing the lower cranial nerves and the apex of the loop touching the exit zone of facial nerve. Vocal cord analysis did not demonstrate any abnormalities. A retro-sigmoid approach was planned for microvascular decompression (MVD) for dual decompression of Vagus and Facial nerves. Intra-operative neuro-physiological monitoring prior to incision decompression increased electromyographic (EMG) activity in VN distribution. Once the VN was decompressed, the EMG normalized. Immediately post-op, she had complete resolution of her symptoms of both HPS and HFS. She remains symptomatic.
Conclusions: Hemi-pharyngeal spasm should be recognized as a neuro-vascular compression syndrome which responds to microvascular decompression. Careful attention to symptoms and imaging is critical.
