More than hemifacial spasm? A case of unilateral facial spasms with systematic review of red flags

  • Jirada Sringean
    Affiliations
    Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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  • Dirk Dressler
    Affiliations
    Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany
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  • Roongroj Bhidayasiri
    Correspondence
    Corresponding author at: Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Chulalongkorn University Hospital, 1873 Rama 4 Road, Bangkok 10330, Thailand.
    Affiliations
    Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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Published:October 13, 2019DOI:https://doi.org/10.1016/j.jns.2019.116532

      Highlights

      • Unilateral facial spasms are not always caused by hemifacial spasm.
      • There are several red flags suggesting alternative diagnoses that are not HFS.
      • A systematic review was conducted to identify a comprehensive list of red flags.
      • Considering the full spectrum of UFS and looking for red flags not seen in HFS helps avoid a misdiagnosis of HFS.

      Abstract

      Unilateral facial spasms (UFS) are frequently caused by hemifacial spasm (HFS), a disorder that usually results from vascular loop compression at the root exit zone of the facial nerve. However, UFS can also be a manifestation of other conditions, including brainstem tumours or demyelination, post-Bell's synkinesis, lesions of the facial nerve in the Faloppio canal and the parotid gland, dystonia, epilepsy, psychogenic conditions, tics and hemimasticatory spasm. In this report, we present a case of UFS, not due to HFS, highlighting clinical red flags for an alternative diagnosis. In addition, a systematic review was conducted to provide a comprehensive summary of UFS differential diagnoses with a list of red flags to assist neurologists in the evaluation of patients with UFS.

      Keywords

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