Painful tic convulsif is a syndrome restricted to paroxysmal dysfunction of the fifth and seventh cranial nerves. It occurs primarily in women over the age of 50 years and is usually associated with an ectatic vertebrobasilar artery--less frequently an arteriovenous malformation or cholesteatoma--which compresses the trigeminal and facial nerve roots in the posterior fossa. In rare instances this syndrome may be caused by disseminated sclerosis. Because of the high incidence of posterior fossa lesions in painful tic convulsif, a complete neurological evaluation including computerised transaxial tomography and vertebrobasilar angiography should be performed in every case.
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