Neuroimaging Findings in Hemifacial Spasm: A Single-Center Experience

Abstract

Introduction: In this study, we documented the demographic, etiological, clinical and radiological features of our patients with primary hemifacial spasm (HFS). We also wanted to emphasize that there may be an association between idiopathic intracranial hypertension (IIH) and HFS. Methods: Fifty-five patients diagnosed with HFS (28 women) who were followed up in the Movement Disorders Outpatient Clinics of the Department of Neurology University of Health Sciences Turkey, Istanbul Bagolar Training and Research Hospital between January 2017 and January 2022 were included in this study. Demographic, clinical, and radiological findings were retrospectively reviewed. Depending on radiological findings, patients were divided into three groups: a) Normal findings, b) Incidental findings that did not appear to be related to clinical findings, and c) vascular abnormalities at the level of the brainstem. Results: Only 23 patients had no atherosclerotic risk factors. While magnetic resonance imaging of the brain was normal in 23 patients, 19 patients had ischemic white matter changes, 5 patients had partial empty sella, 7 patients had dolichoectatic basilar artery, and 1 patient had a compression of the anterior segment of the left superior cerebellar artery to the 7th cranial nerve. Based on the history and clinical findings, lumbar puncture was performed in 4 patients, and 3 of them were diagnosed with idiopathic IIH with HIS, and they were treated with acetazolamide. fifty-one patients were treated with botulinum toxin injections only. Conclusion: Vascular compression is often noted on imaging of patients with primary HIS, but as in our case series, an empty sella finding in patients with chronic headache may be a sign of IIH and should not be overlooked. Also, HFS may be an uncommon presentation of IIH, and symptoms of HFS may improve with treatment of IIH. Additionally, the presence and history of Coronavirus disease-2019 infection should be questioned in newly admitted cases.