Postural fluctuation of hemifacial spasm

Abstract

A patient is described who demonstrated an impressive fluctuation in the severity of hemifacial spasm with change in head position. Postmortem examination revealed a large fusiform aneurysm impinging on the facial nerve.

Position‐Related Paroxysmal Facial Twitching

“…2 Associated vascular compression identified in our case could potentially explain this observation and the position-related HFS as well reported in other 2 cases decades ago, with one occurring when lying down and another occurring when leaning towards the contralateral side. 3,4 In a different case series, more than 90% of patient with HFS were found to be due to the compression of the REZ of the CN7 during decompression surgery, 1 with anterior inferior cerebellar artery, vertebral artery, posterior inferior cerebellar artery, basilar artery and veins commonly involved, followed by mass, demyelinating disease, lacunar stroke and facial nerve injury as other causes. 1 A similar mechanism also explains other microvascular compression syndromes involving CN 5, 8 and 11, 5 causing trigeminal neuralgia, vestibulocochlear neuralgia and vestibular paroxysmia, and glossopharyngeal neuralgia.…”