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      Hemifacial spasm is not affected by state of consciousness: a case report


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           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.

          Case presentation

          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40001-021-00616-5.

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          Most cited references18

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          Peripherally induced movement disorders.

          Peripherally induced movement disorders may be defined as involuntary or abnormal movements triggered by trauma to the cranial or peripheral nerves or roots. Although patients often recall some history of trauma before the onset of a movement disorder, determining the true relationship of the disorder to the earlier trauma is often difficult. The pathophysiology of these disorders is reviewed.
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            The other Babinski sign in hemifacial spasm.

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              Distinguishing features of psychogenic (functional) versus organic hemifacial spasm


                Author and article information

                Eur J Med Res
                Eur J Med Res
                European Journal of Medical Research
                BioMed Central (London )
                7 December 2021
                7 December 2021
                : 26
                [1 ]GRID grid.452435.1, ISNI 0000 0004 1798 9070, Department of Neurology, , First Affiliated Hospital of Dalian Medical University, ; Dalian, China
                [2 ]GRID grid.452435.1, ISNI 0000 0004 1798 9070, Department of Emergency, , First Affiliated Hospital of Dalian Medical University, ; Dalian, China
                [3 ]GRID grid.452435.1, ISNI 0000 0004 1798 9070, Department of Neuroelectrophysiology and Botulinum Toxin Clinic, , First Affiliated Hospital of Dalian Medical University, ; Dalian, China
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funded by: FundRef http://dx.doi.org/10.13039/501100011321, Key Laboratory of Highway Construction and Maintenance Technology in the Loess Region of Shanxi Transportation Research Institute;
                Award ID: LNCCC-C06-2015
                Award Recipient :
                Case Report
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                © The Author(s) 2021

                hemifacial spasm,coma,differential diagnosis,intensive care unit
                hemifacial spasm, coma, differential diagnosis, intensive care unit


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