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Hemifacial spasm due to a tentorial paramedian meningioma: a case report
I Cancelli1, L Cecotti, L Valentinis
1Neurologia-Neurofisiopatologia, Department of Neurosciences, Azienda Ospedaliera S. Maria della Misericordia, Piazzale S. Maria della Misericordia 15, I-33100, Udine, Italy. icancelli@hotmail.com
Abstract:
Hemifacial spasm (HFS) is a movement disorder characterised by involuntary paroxysmal facial movements that usually involve the orbicularis oculi and then spread to the other facial muscles. A microvascular compression and demyelination of the seventh nerve at its exit from the brain stem is considered to be the main aetiology of HFS. In addition to rare idiopathic (cryptogenetic) cases, others causes of HFS exist: tumours or vascular malformations have been described, of both the ipsilateral and contralateral cerebellopontine angle (CPA). However, space-occupying lesions in locations other than CPA are usually not thought to be responsible for HFS. Here we describe the case of a 45-year-old woman suffering from HFS, who dramatically improved after surgical removal of a tentorial paramedian meningioma.
Insights
Hemifacial spasm (HFS), a disorder of involuntary facial movements, typically stems from seventh nerve compression. This case highlights a rare cause: a tentorial meningioma, successfully treated with surgery.
Area of Science:
- Neurology
- Neurosurgery
- Movement Disorders
Background:
- Hemifacial spasm (HFS) is characterized by involuntary facial muscle contractions, often linked to neurovascular compression of the seventh cranial nerve.
- While cerebellopontine angle (CPA) lesions are known causes, HFS from other intracranial locations is uncommon.
Observation:
- A 45-year-old woman presented with symptoms of hemifacial spasm.
- Imaging revealed a tentorial paramedian meningioma as the likely cause.
Findings:
- Surgical resection of the tentorial meningioma led to significant improvement in the patient's hemifacial spasm.
- This case demonstrates that meningiomas, even outside the CPA, can cause HFS.
Implications:
- This finding expands the differential diagnosis for hemifacial spasm, suggesting a broader range of potential causative lesions.
- Highlights the importance of thorough neuroimaging in HFS cases, considering lesions beyond the typical CPA.
- Surgical management of meningiomas can be an effective treatment for HFS when they are the underlying cause.