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Hemifacial spasm: importance of a complete investigation.

The authors report the experience of the Clinique d'O.R.L. de l'Université de Bordeaux II in the management of hemifacial spasm. The recent diagnostic and therapeutic progress in otoneurology has revealed an organic etiology for many cases of hemifacial spasm. The recent diagnostic and therapeutic progress in otoneurology has revealed an organic etiology for many cases of hemifacial spasm. From their experience, they propose a complete investigation for all cases of hemifacial spasm. The disorder is labelled as being idiopathic only if the complete investigation is negative.

Adult↗

[A case report of hemangioma of the petrous bone which caused facial spasm and facial palsy].

A rare case of hemangioma of the petrous bone is described. A 31-year-old woman suffered from right facial twitching and palsy. So she underwent a craniectomy intending microvascular decompression of the facial nerve, but no compressing vessels or tumors were found. Three years later, however, her facial fasciculation disappeared spontaneously, but facial weakness deteriorated and she began to feel vertigo. On admission, neurological examination revealed right facial palsy of the peripheral type, slight hearing disturbance, and canal palsy. Bone-window CT and T2-weighted MRI revealed a small tumor destroying the petrous bone near the geniculate portion of the facial nerve. Using the epidural subtemporal approach, the tumor was totally removed and the facial nerve remained intact. Histologically it was diagnosed as hemangioma. Hemangioma of the skull base bone is rare, and it is interesting that the tumor in this case caused abnormal facial contraction like hemifacial spasm.

Adult↗

[Hemifacial spasm].

A patient with hemifacial spasm is presented and the surgical treatment discussed. The compression was located at the level of the vascular supply of the left facial nerve trunk. Through a left suboccipital retromastoid craneotomy a microscopic vascular decompression was performed with satisfactory results.

Adult↗

Hemifacial spasm: MR imaging features.

MR imaging was used to evaluate the relationship of the root exit zone of the seventh cranial nerve to surrounding vascular structures in 13 patients with clinically documented hemifacial spasm and in 70 asymptomatic patients. MR imaging clearly demonstrated the course of the seventh nerve from the root exit zone of the brainstem to the internal auditory canal and its relationship to the surrounding vertebrobasilar system. The presence of a vascular structure at the root exit zone of the seventh nerve was identified in all 13 patients with hemifacial spasm. In the 70 asymptomatic patients, examination of 140 seventh nerves revealed that 21% had contact by a vascular structure at the root exit zone of the seventh nerve. Our results indicate that although neurovascular contact may be asymptomatic, MR demonstration of a vascular structure at the root exit zone of the seventh cranial nerve in a patient with hemifacial spasm may implicate neurovascular compression as the cause of symptomatology. This finding may alter therapeutic management. Because of the inherent limitations of CT in the visualization of posterior fossa structures, MR imaging should be considered the initial screening procedure in the assessment of patients with hemifacial spasm.

Adult↗

On a case of early-onset post-traumatic facial hemispasm.

In a 49 year old woman an injury to the right frontotemporal region was quickly followed first by paresis and then by spasm of the right side of the face. The early onset of the spasm prompts a critical review of current views on the pathogenesis of facial spasm.

Brain Concussion↗

Melatonin secretion and the pathophysiology of Meige's disease (idiopathic orofacial dystonia): a hypothesis.

Meige's disease is a form of focal dystonia characterized by symmetric dystonic spasms of facial muscles, sometimes associated with dystonic movements of other midline muscle groups. The etiology and pathophysiology of the disease have not been established. There is evidence that Meige's disease may result from striatal dopaminergic preponderance coupled with cholinergic overactivity. Several authors have noted a high prevalence of depression in patients with Meige's disease, suggesting a common neurochemical abnormality. Depression, in turn, is associated with decreased pineal melatonin secretion. We propose, based on studies demonstrating that melatonin regulates dopaminergic, cholinergic and GABA-ergic functions, that alterations in melatonin functions may enhance the development of the disease. This hypothesis may open new avenues toward understanding the pathophysiology of the disease and developing newer therapeutic strategies.

Bipolar Disorder↗

[Intraoperative brainstem auditory evoked potential in the microvascular decompression of the 5th and 7th cranial nerves].

Microvascular decompression techniques are rational surgical procedures for treating trigeminal neuralgia and facial hemispasm, with results ranging from good to excellent in 90% of cases. Among the most frequent complications recorded in the literature concerning these decompressions, impairment of the facial nerve and auditory nerve account for 5% to 10% due to mechanical traction and/or vascular injury. The peroperative use of early brain-stem evoked potentials (BAEP) was performed on 17 patients in a series of 325 decompressions of the trigeminal nerve, and on 17 patients in a series of 25 decompressions for facial hemispasm. Such peroperative monitoring is considered to be most important in the surgical technique. The author reports on his experience and results.

Adult↗

[Arteriovenous anastomosis in nasal cavities using microcorrosion technique].

In the present study the morphology of arteriovenous anastomoses in the nasal area are analyzed using the microcorrosion technique. This technique calls for perfusion of the vascular system, passing through the left ventricle, with Batson's of the vessels. For the first time in the microcorrosion study of the nasal vascular network human fetuses (from the 12th to 24th week of intrauterine life) obtained from spontaneous abortions were used as well as rats weighing from 250 to 300 gr. The animals were anesthetized with sodium thiopental prior to administration of the resin. A specimen containing the facial muscles, the nasal pyramid, the maxillary bone and the palatine bones was excised. Then, from this specimen the nasal septum and the two lateral portions of the nose were obtained. The bony and soft perivascular tissues were removed by placing the casts in an aqueous 20% KOH solution. Finally the corrosion cases were observed under a scanning electron microscope (EM). Within the nasal cavities the microcorrosion technique makes it possible to identify three different vascular layers: superficial, intermediate and deep. In the latter it proved possible to visualize the two types of arteriovenous anastomoses: i.e. simple and complex. On the basis of both vascular course and the impressions left by the endothelial cell nuclei it proved possible to differentiate between the arterial and venous portions of the anastomoses.

Animals↗

[Relevance of combined electrodiagnosis in facial hyperkinesia].

We present a combined electrophysiological diagnostic procedure for patients with facial hyperkinesia. With the new method of magnetic stimulation a central cortical stimulation is possible to represent the total way of the facial nerve. The combination of magnetic stimulation with other methods such as the blink reflex may lead to topodiagnostic statements in facial hyperkinesias.

Cerebral Cortex↗

[Botulinum toxin treatment of synkinesia following facial paralysis].

We report ten patients with unilateral synkinesias after facial palsy treated with botulinum toxin injections. All patients suffered from extensive mass movements around the eye. After periocular injections all patients showed much improvement: a period of 11 weeks free of symptoms was followed by a 9-week period of minimal symptoms. There were no important complications. The use of botulinum toxin injections is an effective therapy for mass movements after defect healing of facial palsy.

Adult↗