Hemifacial spasm is not affected by state of consciousness: a case report

Tao Li,Zhuo Feng,Zhanhua Liang,Chunli Song

doi:10.1186/s40001-021-00616-5

Abstract

Background Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how HFS manifests under disturbance of consciousness. Here, we report a case of primary HFS in which the patient's symptoms persisted in a coma.Case presentationA 74-year-old female with right-sided primary HFS for 20 years and had received botulinum toxin injections in our hospital. Unfortunately she was carried to emergency department after traumatic right pneumothorax by accident. During the emergency treatment, she lost consciousness due to simultaneous cardiac arrest and respiratory arrest. She was then admitted to the emergency intensive care unit for further treatment. During her hospitalization, she was in a coma with stable vital signs and persisting symptoms of HFS. Thus, a multidisciplinary consultation was requested to identify whether it was focal cortical seizures involving the right-side facial muscles. Physical examination revealed brief involuntary clonic or tonic contractions accompanied with the ‘Babinski-2 sign’. A combination of relevant data, including her past history, clinical presentation and a negative computed tomography scan of the head, led to a diagnosis of right-sided HFS. As the symptoms of HFS are not life-threatening, the use of anticonvulsants is unnecessary.ConclusionsFor the layperson, it is crucial to seek a multidisciplinary consultation to obtain a correct diagnosis.

Highlights

Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve
HFS is not fatal, it often leads to social embarrassment and interference with vision from involuntary eye closure leading to functional disability [1,2,3]
A multidisciplinary consultation was request to identify whether it was focal cortical seizures involving the right facial muscles. Though she was under coma status and on a life-support machine, the physical examination revealed right-side facial musculature involved in involuntary movement (Fig. 1)

Summary

Introduction

Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve. It is characterized by involuntary clonic or tonic contractions of the facial expression muscles, usually unilateral and *Correspondence: zhanhualiangdl@126.com 1 Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China Full list of author information is available at the end of the article rarely bilateral, beginning in the periorbital musculature usually starting in the low eyelid and progressing to the perioral, platysma and other facial expression muscles [4]. We report a case of primary HFS in which the patient’s symptoms persisted in a coma.

Results

Conclusion