Hemifacial Spasm — SCE Neurology MCQ

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ModerateMovement DisordersHemifacial SpasmSCE Neurology

A 60-year-old woman presents with a 4-month history of left-sided facial twitching. It began around the left eye and has spread to involve the entire left hemiface. The twitching is involuntary, synchronous, and persists during sleep. MRI brain shows a vascular loop (left PICA) compressing the left facial nerve at the root exit zone. What is the diagnosis?

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Correct answer: A — Hemifacial spasm

Hemifacial spasm is caused by neurovascular compression of the facial nerve (CN VII) at the root exit zone, most commonly by the PICA or AICA. It presents with involuntary, synchronous, tonic-clonic contractions of the muscles on one side of the face, typically starting around the eye and spreading to involve the lower face. It persists during sleep (distinguishing it from blepharospasm). Treatment options include botulinum toxin injections or microvascular decompression. A: Bell palsy causes weakness, not spasm. C: Blepharospasm is bilateral and does not persist in sleep. D: Facial myokymia has undulating muscle movements and is associated with brainstem pathology. E: Tics are suppressible and not caused by nerve compression.

Reference: ABN Movement Disorders Guidelines; NICE IPG491 MVD for Hemifacial Spasm