1. Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 64-year-old man with right facial pain and spasms

2. Vignette A 64-year-old man presented for two-week worsening of a two-year history of paroxysmal, lancinating right facial pain and spasms. Head CT demonstrated a tortuous and ectatic vertebral-basilar system. MRI confirmed a dolichoectatic basilar artery that distorted the right trigeminal and facial nerve roots. Lakhan et al.

3. Brain MRI Lakhan et al.

4. Brain MRI Lakhan et al.

5. Concurrent hemifacial spasm and trigeminal neuralgia due to vertebrobasilar dolichoectasia He failed conservative medical management including carbamazepine, oxcarbazepine, and levitiracetam. He underwent Gamma-knife radiosurgery with few months of pain relief and was offered botulinum neurotoxin injection for spasms. This case represents a rare presentation of concurrent hemifacial spasm and trigeminal neuralgia linked to an ectatic basilar artery. 1 Lakhan et al.