Reader Response: Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis
WayneCornblath, Neuro-ophthalmologist, Departments of Ophthalmology & Visual Sciences And Neurology WK Kellogg Eye Center University of Michigan
EricEggenberger, Professor, Mayo Clinic Florida
Submitted August 23, 2022
We read this case with interest, but we have some questions for the authors. The video demonstrates orbicularis and frontalis contraction occurring simultaneously on the left and right sides, with cheek contraction on the right side only. In our experience, patients with bilateral hemifacial spasm have contractions that are asynchronous left- and right-sided movements. The likelihood of a peripheral cause of bilateral hemifacial spasm producing identically timed synchronous contractions in both facial nerves seems very low. We are also unsure of the proposed mechanism of temporal arteritis for causing facial nerve irritation. A central cause with some asymmetry seems much more likely; we wonder if epileptic pathophysiology was explored, given the left-sided MRI-demonstrable cerebral ischemic predilection.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Sechi E, Gallus E, Solla P, et al. Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis. Neurology. 2022;99(6):256-257. doi:10.1212/WNL.0000000000200837
We read this case with interest, but we have some questions for the authors. The video demonstrates orbicularis and frontalis contraction occurring simultaneously on the left and right sides, with cheek contraction on the right side only. In our experience, patients with bilateral hemifacial spasm have contractions that are asynchronous left- and right-sided movements. The likelihood of a peripheral cause of bilateral hemifacial spasm producing identically timed synchronous contractions in both facial nerves seems very low. We are also unsure of the proposed mechanism of temporal arteritis for causing facial nerve irritation. A central cause with some asymmetry seems much more likely; we wonder if epileptic pathophysiology was explored, given the left-sided MRI-demonstrable cerebral ischemic predilection.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References