An 80-year-old man developed bitemporal headache and scalp tenderness. Both temporal arteries were prominent (Figure, A), with halo sign on ultrasonography.1 Temporal arteritis was diagnosed and oral prednisone (50 mg/d) initiated. Three days later, he developed spasms of the orbicularis oculi and frontalis muscles with eyebrow elevation and eye twitching (other Babinski sign),2 consistent with bilateral hemifacial spasm (Video 1). Brain MRI and time-of-flight angiography revealed exclusively supratentorial acute infarcts (Figure, B and C) without intracranial neurovascular conflicts. Intravenous methylprednisolone (1 g/d for 5 days) was started with resolution of spasms within 24 hours and clinical stabilization. Temporal artery inflammation may cause facial nerve irritation and hemifacial spasm (Figure, D).
(A) Prominent right temporal artery. (B and C) Brain MRI DWI images showing multiple infarcts. (D) Pathophysiologic hypothesis: TBFN passes in the same anatomical region as the FBSTA and is sometimes injured in temporal artery biopsies (not performed in our patient). Temporal artery inflammation may cause TBFN irritation and hemifacial spasm predominantly involving the upper facial muscles. DWI = diffusion-weighted image; FBSTA = frontal branch of the superficial temporal artery; TBFN = temporal branch of the facial nerve.
Video 1
Bilateral hemifacial spasm (right > left).Download Supplementary Video 1 via http://dx.doi.org/10.1212/200837_Video_1
Study Funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Acknowledgment
The authors thank the patient for consenting to the use of his medical records, video, and pictures for this report.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Roy Strowd III, MD, MEd, MS.
Teaching slides links.lww.com/WNL/C101
- Received November 12, 2021.
- Accepted in final form April 22, 2022.
- © 2022 American Academy of Neurology
References
Letters: Rapid online correspondence
- Author Response: Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis
- Reader Response: Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis
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