Symptom of Hemifacial Spasm Is Not Affected By State of Consciousness: A Case Report

Abstract

Background: Hemifacial spasm is characterised by twitching of the muscles innervated by facial nerve. It is believed to result from hyperexcitability of the facial nerve nucleus or ephaptic transmission within the proximal facial nerve segment of the facial nerve nucleus. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how it manifests under disturbance of consciousness. Herein we report a case whose symptoms sustained under coma status.Case presentation: A 74-year-old female suffered from right side primary hemifacial spasm for 20 years and used to accept botulinum toxin injection in our clinic. Unfortunately she was carried to emergency department in our hospital after traumatic right pneumothorax by accident. During emergency rescue cardiac arrest and apnea happened. She was then hospitalized in emergency intensive care unit for further therapy. During hospitalization, she was under coma status. Vital signs were stable and symptoms of hemifacial spasm sustained. A multidisciplinary consultation was request 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. Synthesize the relevant data including past history, clinical manifestation and negative head computed tomography scanning, diagnosis was made as hemifacial spasm. Herein symptoms of hemifacial spasm were not life threatening and anti-epileptic drug was not necessary.Conclusions: It’s better for nonspecialists to prompt diagnose instead of under or misdiagnose the symptoms as seizures as inappropriate diagnostic or therapeutic measures may be taken inadvertently.