Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Eur J Med Res. 2021 Dec 7;26(1):138. doi: 10.1186/s40001-021-00616-5.
Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how HFS manifests under disturbance of consciousness. Here, we report a case of primary HFS in which the patient's symptoms persisted in a coma.
A 74-year-old female with right-sided primary HFS for 20 years and had received botulinum toxin injections in our hospital. Unfortunately she was carried to emergency department after traumatic right pneumothorax by accident. During the emergency treatment, she lost consciousness due to simultaneous cardiac arrest and respiratory arrest. She was then admitted to the emergency intensive care unit for further treatment. During her hospitalization, she was in a coma with stable vital signs and persisting symptoms of HFS. Thus, a multidisciplinary consultation was requested 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'. A combination of relevant data, including her past history, clinical presentation and a negative computed tomography scan of the head, led to a diagnosis of right-sided HFS. As the symptoms of HFS are not life-threatening, the use of anticonvulsants is unnecessary.
For the layperson, it is crucial to seek a multidisciplinary consultation to obtain a correct diagnosis.
面肌痉挛（HFS）是一种运动障碍，由面神经离开脑干后受到机械压迫引起，其特征为受该神经支配的肌肉短暂或持续抽搐。我们经常在觉醒状态下观察到痉挛。实际上，收缩在睡眠中持续存在。据我们所知，还没有关于 HFS 在意识障碍下表现的报告。在这里，我们报告了一例原发性 HFS 病例，患者在昏迷状态下症状持续存在。
一名 74 岁女性，右侧原发性 HFS 病史 20 年，曾在我院接受肉毒毒素注射治疗。不幸的是，她因意外右侧气胸被送往急诊科。在紧急治疗过程中，她因同时发生心脏骤停和呼吸骤停而失去意识。随后，她被收入急诊重症监护病房进一步治疗。在住院期间，她处于昏迷状态，生命体征稳定，但仍存在 HFS 症状。因此，请求多学科会诊以确定是否涉及右侧面部肌肉的局灶性皮质发作。体格检查显示短暂的不自主阵挛或强直性收缩，并伴有“巴氏征 2 型”。结合包括既往病史、临床表现和头部 CT 扫描均为阴性等相关数据，诊断为右侧 HFS。由于 HFS 症状不危及生命，因此无需使用抗癫痫药。
对于非专业人士来说，寻求多学科会诊以获得正确的诊断至关重要。
