A 71-year-old has intermittent unilateral contractions beginning around one eye and spreading to the ipsilateral lower face. Facial power and

Question

A 71-year-old has intermittent unilateral contractions beginning around one eye and spreading to the ipsilateral lower face. Facial power and sensation are normal between episodes; MRI shows a vascular loop at the facial-nerve root-exit zone. What is the most appropriate symptomatic treatment?

Accepted Answer

Offer targeted botulinum toxin injections to the involved facial muscles as symptomatic treatment

Answer

Use oral corticosteroids because a vascular loop produces inflammatory facial neuritis

Answer

Start levodopa because unilateral facial contractions indicate parkinsonian hypomimia

Answer

Start carbamazepine because facial contractions from vascular compression are trigeminal neuralgia

Answer

Offer microvascular decompression as first-line treatment without a trial of less invasive therapy

Hemifacial spasm — SCE Neurology MCQ

A 71-year-old has intermittent unilateral contractions beginning around one eye and spreading to the ipsilateral lower face. Facial power and sensation are normal between episodes; MRI shows a vascular loop at the facial-nerve root-exit zone. What is the most appropriate symptomatic treatment?