1
|
Kalher M, Kaushik M, Vasudevan H, Narendran S, Mani KK, Ramakrishnan K, Rangarajan V, Shah VM. Clinical Profile of Patients with Hemifacial Spasm at a Tertiary Eye Care Center in South India: A Retrospective Study. J Curr Ophthalmol 2023; 35:395-400. [PMID: 39281403 PMCID: PMC11392308 DOI: 10.4103/joco.joco_295_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 09/18/2024] Open
Abstract
Purpose To assess the incidence and clinical profile of hemifacial spasm (HFS) and the association between HFS and systemic diseases. Methods This retrospective study was carried out on 85 patients with HFS, presenting at a tertiary eye care center in South India. Demographic and clinical details were recorded for all patients. Of these, the patients who had undergone magnetic resonance imaging (MRI) of the brain were analyzed for primary and secondary HFS. Results The mean age of the patients was 56.11 ± 12.51 years. The age at onset of HFS was 54.9 ± 12.7 years. The disease duration was 9.51 ± 7.28 years. Male:female ratio was 1:1.17. The right side was involved in 31 patients (36.47%) and the left side in 54 patients (63.52%). MRI was performed in 54 (63.52%) patients and showed neurovascular conflict in 22 (40.74%) patients and space-occupying lesions in 2 (3.70%) patients. Forty-nine (57.64%) patients had primary HFS, while five (5.88%) patients had secondary HFS due to old facial palsy in 3 and space-occupying lesions in two patients. Twenty (23.52%) patients received botulinum toxin A with a good response. Type of HFS had a significant association with hypertension (P = 0.046) while no significant association was present between laterality of HFS and systemic diseases (P > 0.05 each). Multivariate analysis showed a marginally significant association between type of HFS and hypertension (P = 0.057). Conclusions Primary HFS was the main type of HFS with female dominance and predilection for the left side. Hypertension had a relationship with HFS that needs to be investigated further for its causal nature.
Collapse
Affiliation(s)
- Manisha Kalher
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Madhurima Kaushik
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Haritha Vasudevan
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | | | - Karthik Kumar Mani
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Kavitha Ramakrishnan
- Department of General Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Viji Rangarajan
- Orbit and Oculoplasty Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Virna Mahesh Shah
- Neuro-Ophthalmology Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| |
Collapse
|
2
|
Dudoit T, Balossier A, Reyes-Botero G, Laigle-Donadey F, Emery E, Blond S, Carluer L, Lechapt-Zalcman E, Delattre JY, Guillamo JS. Adult brainstem glioma presenting with isolated persistent hemifacial spasm or facial nerve palsy. Rev Neurol (Paris) 2021; 177:1276-1282. [PMID: 34272066 DOI: 10.1016/j.neurol.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
OBJECT Adult brainstem gliomas are a rare group of heterogeneous brain tumors. Classical clinical presentation includes progressive impairment of cranial nerves associated with long tract signs. The prognosis and response to treatment are poor; nevertheless, some patients do have a long survival. The objective of this study was to describe a series of patients with an isolated persistent hemifacial spasm and/or facial nerve palsy as the presenting symptom of a brainstem glioma. METHODS Fourteen patients from 3 French hospitals (Paris, Caen, Lille) were included. Clinical and radiological features and overall survival were retrospectively analyzed. A review of the literature of similar cases was performed. RESULTS Mean age at diagnosis was 35 years (range 19-57 years). Mean duration of facial nerve involvement before diagnosis was 17 months (range 1-48 months). Tumors were characterized on MRI by a lateralized location in the pons, a T1-weighted hyposignal, a T2-weighted hypersignal and no contrast enhancement after Gadolinium injection except for 2 cases. Biopsies were performed in 10 cases and showed 8 low-grade and 2 high-grade gliomas. All the patients were initially treated with radiotherapy and 6 patients with chemotherapy after progression. Eleven patients died from tumor progression. Median survival time was 90 months. CONCLUSIONS Adult brainstem gliomas revealed by a progressive isolated involvement of the facial nerve seem to have particular clinico-radiological features of slow progressive tumors and may be associated with long patient survival.
Collapse
Affiliation(s)
- T Dudoit
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France
| | - A Balossier
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France
| | - G Reyes-Botero
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - F Laigle-Donadey
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - E Emery
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France
| | - S Blond
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
| | - L Carluer
- Service de neurologie, CHU de Caen, 14000 Caen, France
| | | | - J-Y Delattre
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - J-S Guillamo
- Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France; Service de neurologie, CHU de Caen, 14000 Caen, France; Service de neurologie, CHU de Nîmes, 30029 Nîmes, France.
| |
Collapse
|
3
|
Banerjee P, Alam MS, Koka K, Pherwani R, Noronha OV, Mukherjee B. Role of neuroimaging in cases of primary and secondary hemifacial spasm. Indian J Ophthalmol 2021; 69:253-256. [PMID: 33463567 PMCID: PMC7933878 DOI: 10.4103/ijo.ijo_415_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The objective of this study was to analyze the role of neuroimaging and documenting various intracranial pathologies in primary and secondary hemifacial spasm. Methods: This retrospective study included patients with HFS who had undergone neuroimaging. The demographic profile, onset, progression, neuroimaging findings, and types of HFS were documented and analyzed. Results: A total of 202 patients (male = 110, female = 92) were included. The mean age of the study population was 51.81 ± 11.76 years. The right side was involved in 104 patients, the left side was involved in 97 patients and bilateral involvement was observed in one patient. Primary HFS: secondary HFS was 9.6:1. The mean age of onset of the spasms in the primary HFS group was 49.26 ± 8.35 years and in secondary HFS was 43.13 ± 12.12 years respectively. The anterior inferior cerebellar artery was the major vessel causing neurovascular conflict in primary HFS (n = 55). Facial nerve palsy was the most common cause (n = 13) of secondary HFS followed by cerebellopontine angle (CPA) tumors. Conclusion: The hemifacial spasm occurs mostly in the fifth decade of life. Primary HFS is more prevalent than secondary HFS. Clinical distinction between them is difficult. Neuroimaging is essential to detect the conflicting vasculature in cases of primary HFS and pathologies like CPA tumor, cyst, and aneurysms in cases of secondary HFS.
Collapse
Affiliation(s)
- Prabrisha Banerjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services Aditya Birla Sankara Nethralaya, Kolkata (A Unit of Medical Research Foundation, Chennai), West Bengal, India
| | - Kirthi Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Ruchi Pherwani
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | | | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| |
Collapse
|
4
|
Machado RA, Moubayed SP, Khorsandi A, Hernandez-Prera JC, Urken ML. Intermittent facial spasms as the presenting sign of a recurrent pleomorphic adenoma. World J Clin Oncol 2017; 8:86-90. [PMID: 28246588 PMCID: PMC5309717 DOI: 10.5306/wjco.v8.i1.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/17/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms. However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy. We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland (i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms. We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology. Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies. To date the development of facial spasm has not been reported with parotid malignancies. The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle (termed primary or idiopathic) (62%), hereditary (2%), secondary to Bell’s palsy or facial nerve injury (17%), and hemifacial spasm mimickers (psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm) (17%). Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.
Collapse
|
5
|
Facial spasms, but not hemifacial spasm: a case report and review of literature. Childs Nerv Syst 2016; 32:1735-9. [PMID: 26984806 DOI: 10.1007/s00381-016-3057-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Facial spasms represent a complicated array of neurological motor disorders with unique diagnostic and treatment algorithms. Due to the rarity of many of these disorders in the pediatric population, special care must be taken in identifying subtle differences in presentation of these disorders. METHODS We present a case of a 3-year-old boy diagnosed with a brainstem ganglioglioma, Chiari 1 malformation, and a 2-year history of left-sided facial spasms. Stereotyped facial contractions and subtle eye deviation occurred every 10 s, with downward movement rather than upward elevation of the eyebrow. RESULTS MRI revealed absence of a clear compressive vessel of the centrally-myelinized portion of the facial nerve, and EMG of the left facial nerve demonstrated no abnormal motor response or evidence of "lateral spread." Given these findings, a diagnosis of hemifacial seizures was made. Microvascular decompression was not recommended, and botulinum toxin injection was not pursued; however, the patient has remained refractory to antiepileptic drugs, possibly due to biochemical alteration by his ganglioglioma. He may eventually require surgical debulking should his symptoms progress. CONCLUSION Hemifacial spasm is a well-recognized disorder, but similar conditions can, at times, imitate its appearance. While our patient presented with facial spasms, his clinical history, examination, and radiographic and electrophysiological findings were more consistent with hemifacial seizures secondary to a brainstem lesion, rather than hemifacial spasms. It is important to distinguish the two entities, as misdiagnosis and inappropriate diagnostic or therapeutic measures may be taken inadvertently.
Collapse
|