A 42 year old woman with a history of an incompletely remitted peripheral left facial nerve palsy that was followed by clusters of hemifacial spasm and paroxysms of lancinating pain located behind the left ear and radiating to the ipsilateral eye, the neck, or shoulder, was admitted for re-evaluation due to additionally manifested short lasting syncope-like episodes of increasing frequency. Beneath a mild residual facial nerve palsy no further focal findings were documented. …