Hemifacial spasm through changes of cerebrospinal fluid pressure in idiopathic intracranial hypertension

Hemifacial spasm (HFS) is a rare complication of idiopathic intracranial hypertension (IIH); hence, little is known about its pathophysiology and treatment options. Here, we report a 29-year-old woman with a 3-month history of IIH and HFS. Following a diagnostic and therapeutic lumbar puncture, she suffered from attacks of HFS for a few days every time she rose from a supine position. The relatively sudden drop in cerebrospinal fluid (CSF) pressure led to frequent HFS attacks, which, in contrast to the attacks in the previous months, were strictly observed only when getting up from the supine position. This observation suggests changes in CSF pressure as the likely pathophysiological mechanism responsible for HFS in IIH, rather than the absolute CSF pressure. She was then successfully treated with topiramate, a known therapeutic option in IIH, but not yet described for HFS in IIH.