Tani Shigeru, Inazuka Mayuko, Maegawa Tatsuya, Takahashi Yuichi, Kikuchi Asami, Yokosako Suguru, Yoshimura Chika, Koseki Hirokazu, Ohbuchi Hidenori, Hirota Kengo, Hagiwara Shinji, Hirasawa Motohiro, Sasahara Atsushi, Kasuya Hidetoshi
Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Surg Neurol Int. 2017 Jun 5;8:96. doi: 10.4103/sni.sni_370_16. eCollection 2017.
Hemifacial spasm is usually diagnosed by inspection which mainly identifies involuntary movements of orbicularis oculi. Assessing abnormal muscle responses (AMR) is another diagnostic method.
We report a case of left hemifacial spasm without detectable involuntary facial movements. The patient was a 48-year-old man with a long history of subjective left facial twitching. On magnetic resonance imaging (MRI), the left VIIth cranial nerve was compressed by the left anterior inferior cerebellar artery (AICA), which was in turn compressed by the left vertebral artery. We initially treated him with botulinum toxin. We were able to record AMR, and hemifacial spasm occurred after AMR stimulation, although no spasm was detectable by inspection. Subsequently, we performed microvascular decompression with transposition of the AICA that compressed the VIIth cranial nerve. His hemifacial spasm resolved by 5 weeks after surgery and was not induced by AMR stimulation.
Hemifacial spasm can sometimes be diagnosed by detecting AMR rather than by visual inspection. We propose that such hemifacial spasm should be termed nonspastic hemifacial spasm.
面肌痉挛通常通过检查来诊断，主要是识别眼轮匝肌的不自主运动。评估异常肌肉反应（AMR）是另一种诊断方法。
我们报告一例左侧面肌痉挛患者，未检测到不自主面部运动。患者为一名48岁男性，有长期左侧面部主观抽搐病史。磁共振成像（MRI）显示，左侧第七颅神经被左小脑前下动脉（AICA）压迫，而左小脑前下动脉又被左椎动脉压迫。我们最初用肉毒杆菌毒素对他进行治疗。我们能够记录到AMR，并且在AMR刺激后出现了面肌痉挛，尽管通过检查未检测到痉挛。随后，我们对压迫第七颅神经的AICA进行转位微血管减压术。术后5周他的面肌痉挛得到缓解，且AMR刺激未诱发痉挛。
面肌痉挛有时可通过检测AMR而非目视检查来诊断。我们建议将这种面肌痉挛称为非痉挛性面肌痉挛。
