Hemifacial Spasm as a Rare Clinical Presentation of Idiopathic Intracranial Hypertension: Case Report and Literature Review

Abstract

<jats:sec><jats:title>Objectives:</jats:title><jats:p> To report a rare case of idiopathic intracranial hypertension (IIH) presenting with hemifacial spasm (HFS) and review the current literature. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Case report and literature review. The patient’s medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using PUBMED. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A 43-year-old obese female presented with a 2-year history of left HFS. Electroencephalography and head computed tomography were unremarkable. Magnetic resonance imaging demonstrated bilateral anterior inferior cerebellar artery vascular loops involving the internal auditory canals as well as IIH-associated findings. A lumbar puncture was performed and revealed an elevated opening pressure of 26 cm H<jats:sub>2</jats:sub>0 cerebrospinal fluid. Acetazolamide treatment was then initiated, resulting in complete resolution of the HFS. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> HFS may be a rare presenting manifestation of IIH, and treatment of IIH may result in improvement of HFS symptoms. This is the first report of IIH presenting with HFS in the absence of headache or visual change. As a result, this is the first report of HFS as a presenting manifestation of IIH in Otolaryngology literature. </jats:p></jats:sec>

A Case Report of Idiopathic Intracranial Hypertension With Left-Sided Facial Spasm

“…Lifestyle modifications, including weight loss and dietary changes, are also crucial components of management [ 12 ]. However, atypical presentations, as seen in our case with left-sided facial spasm, can lead to diagnostic challenges and delays in appropriate management [ 2 , 3 , 13 , 14 ]. Therefore, clinicians must remain vigilant and consider IIH in the differential diagnosis of patients presenting with neurological symptoms, even when they are atypical.…”

“…Despite advances in understanding and management, diagnosing and treating IIH can be challenging, particularly when the presentation is atypical [ 13 , 14 ] or when patients have concurrent medical conditions. Therefore, clinicians must maintain a high index of suspicion for IIH and consider a comprehensive differential diagnosis, including uncommon presentations and associated risk factors.…”