Teaching Video NeuroImages: Infratentorial Multiple Sclerosis Relapse Presenting as Continuous Hemifacial Myokymia

Salavisa, Manuel; Serrazina, Filipa; Pires, Pedro; Correia, Ana Sofia

doi:10.1212/wnl.0000000000012052

Cited by 3 publications

(3 citation statements)

References 2 publications

(4 reference statements)

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“…namely tumors, cysticercosis, Guillain-Barre syndrome, or MS. 6 Myokymia may be the presenting feature of MS, 2,3,7-10 as in our case, or may correspond to relapse in a patient with an established multiple sclerosis diagnosis undergoing immunomodulatory or immunosuppressive treatment. 11,12 Also, it is well known that facial myokymia seems to be related to dorsolateral tegmentum pontine lesions concerning the ipsilateral post-nuclear portion of the facial nerve, particularly lateral to its genu. 2 In our case, the initial brain MRI failed to identify the pontine lesion, later described in the follow-up MRI.…”

Section: Discussionmentioning

confidence: 99%

Hemifacial Myokymia as the Presenting Feature of Multiple Sclerosis

Magriço¹

2024

Sinapse

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The clinical presentation of multiple sclerosis (MS) is variable and can pose a diagnostic challenge. A case of unilateral perioral myokymia as the revealing feature of MS is reported. We present the case of a 43-year-old male, observed in our outpatient clinic with a two-week history of continuous involuntary wavelike movement across the left side of his face. Neurological examination revealed left-sided facial myokymia with perioral involvement and hemifacial spasm. Brain magnetic resonance imaging (MRI) showed multiple white matter hyperintensities on T2/FLAIR, suggestive of demyelination, involving periventricular, juxta-cortical regions, and the corpus callosum. Cerebrospinal fluid (CSF) analysis showed CSF-specific oligoclonal bands. The diagnosis of relapsing-remitting multiple sclerosis was made according to the McDonald Criteria from 2017. This case illustrates an unusual presentation of MS and highlights the importance of awareness of possible MS in young adults with facial myokymia, more so when continuous and with perioral involvement.

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Section: Discussionmentioning

confidence: 99%

Hemifacial Myokymia as the Presenting Feature of Multiple Sclerosis

Magriço¹

2024

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“…Facial myokymia is frequently reported as the presenting feature in patients with MS [196][197][198][199][200][201][202][203][204][205][206][207][208][209][210][211]. The lesion is usually attributed to the postnuclear facial fascicular involvement in the dorsolateral pontine tegmentum [212].…”

Section: ) Facial Myokymiamentioning

confidence: 99%

“…The lesion is usually attributed to the postnuclear facial fascicular involvement in the dorsolateral pontine tegmentum [212]. Strictly unilateral myokymia involving peri-oral muscles warrants a search for underlying structural/demyelinating lesion over pons in contrast to eyelid myokymia, which is usually benign without any structural correlations [206].…”

Section: ) Facial Myokymiamentioning

confidence: 99%

Movement Disorders in Multiple Sclerosis: An Update

Ghosh

Roy

Dubey

et al. 2022

Tremor and Other Hyperkinetic Movements

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Background: Multiple sclerosis (MS), a subset of chronic primary inflammatory demyelinating disorders of the central nervous system, is closely associated with various movement disorders. These disorders may be due to MS pathophysiology or be coincidental. This review describes the full spectrum of movement disorders in MS with their possible mechanistic pathways and therapeutic modalities. Methods:The authors conducted a narrative literature review by searching for 'multiple sclerosis' and the specific movement disorder on PubMed until October 2021. Relevant articles were screened, selected, and included in the review according to groups of movement disorders. Results:The most prevalent movement disorders described in MS include restless leg syndrome, tremor, ataxia, parkinsonism, paroxysmal dyskinesias, chorea and ballism, facial myokymia, including hemifacial spasm and spastic paretic hemifacial contracture, tics, and tourettism. The anatomical basis of some of these disorders is poorly understood; however, the link between them and MS is supported by clinical and neuroimaging evidence. Treatment options are disorder-specific and often multidisciplinary, including pharmacological, surgical, and physical therapies.Discussion: Movements disorders in MS involve multiple pathophysiological processes and anatomical pathways. Since these disorders can be the presenting symptoms, they may aid in early diagnosis and managing the patient, including monitoring disease progression. Treatment of these disorders is a challenge. Further work needs to be done to understand the prevalence and the pathophysiological mechanisms responsible for movement disorders in MS.

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The use of botulinum toxin type A in symptomatic therapy and medical rehabilitation of patients with multiple sclerosis

Kostenko

2023

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Teaching Video NeuroImages: Infratentorial Multiple Sclerosis Relapse Presenting as Continuous Hemifacial Myokymia

Cited by 3 publications

References 2 publications

Hemifacial Myokymia as the Presenting Feature of Multiple Sclerosis

Hemifacial Myokymia as the Presenting Feature of Multiple Sclerosis

Movement Disorders in Multiple Sclerosis: An Update

The use of botulinum toxin type A in symptomatic therapy and medical rehabilitation of patients with multiple sclerosis

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