Hemifacial Spasm

Update item information
Identifier Wray_Case937-1_PPT
Title Hemifacial Spasm
Subject Lid twitch; Hemifacial spasm; Neurovascular Compression Syndrome of the Facial Nerve
Creator Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Description The patient is a 72 year old man with myopia, childhood exotropia, progressive age related ptosis and right hemifacial spasm. Hemifacial spasm (HS) most often begins insidiously in the orbicularis oculi muscle in the early stages, as in this man. He presented with a 2 year history of involuntary twitching of the right upper eyelid, which he described as "a quiver". The twitching slowly progressed to involve the ipsilateral facial muscles. On some occasions the twitching was almost continuous and he sat watching television with his hand over his right eye. His hemifacial spasms were aggravated by emotional stress and fatigue and precipitated by active movement of any facial muscle. Just asking him to show his teeth provoked right sided facial spasm. Past History: Negative for trauma, a previous lower motor neuron facial palsy (Bell's Palsy), impaired sensation of the face and face pain. He had no history of deafness or tinnitus. Investigations: Electromyography: Electromyographic study confirmed that the HS was due to brief bursts of normal motor units firing at high frequency. (HS is not a focal dystonia). Brain MRI is required in these cases to rule out: 1.A basilar artery aneurysm 2.An acoustic nerve tumor 3.Posterior fossa meningioma 4.Pontine glioma Brain MRI with contrast showed: A small enchancing vessel crossing the root entry zone of the right 7th and 8th cranial nerve. No corresponding vessel was noted on the controlateral side. Diagnosis: Neurovascular compression syndrome of the facial nerve root Microsurgical decompression: Microsurgical decompression of the facial nerve root was recommended but, not unexpectedly, the patient declined because of the risks of a posterior craniotomy. Botulinum toxin therapy: He was referred to the Movement Disorder Clinic for treatment with Botulinum toxin (BT). BT injections successfully suppressed the HS in this patient and he continued receiving this treatment on a routine basis over many months. See also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/95
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Text; Image
Format application/pdf
Format Creation Created in Microsoft PowerPoint
Relation is Part of 937-1
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6vb1hmc
Setname ehsl_novel_novel
Date Created 2012-07-13
Date Modified 2018-09-24
ID 186813
Reference URL https://collections.lib.utah.edu/ark:/87278/s6vb1hmc
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