Hemifacial spasm: a presenting symptom of Multiple Sclerosis

Taylor Kiser


A 33-year-old African American female presented with a complaint of right upper eyelid twitching for two weeks. The episodes lasted one minute each, occurred several times per day, and were worsening over the last three days. Episodes included involuntary closure of the right upper eyelid with inability to lift the lid. Simultaneously, loss of motor control to the right cheek would occur making formation of words difficult. All symptoms would spontaneously resolve with no residual effects after one minute. She denied confusion, headache, or diplopia. The patient’s medical history was positive for mitral valve prolapse. Family history was positive for Type 2 Diabetes (Father) and Multiple Sclerosis (Mother). Ocular examination with dilation was unremarkable; the patient’s lid position, function, ocular alignment and motility were normal. Symptoms did not occur during the exam. The patient was diagnosed with right hemifacial spasm based on her symptoms. An MRI of the brain with and without contrast was immediately ordered. The imaging revealed several nonspecific, deep, white matter T2 weighted hyperintensities involving both cerebral hemispheres. Radiology listed hypertension, vasculitis, Lyme disease, granulomatous disease, or demyelinating disease as possible etiologies. The patient was referred to a local neurologist, who reviewed the imaging and performed further work-up. The work-up ruled out most of the proposed etiologies of the MRI abnormalities; however, studies of the patient’s cerebrospinal fluid revealed an elevated Immunoglobulin G index and presence of four or more oligoclonal bands. Ultimately, all of the findings led to the formal diagnosis of Multiple Sclerosis. Treatment with Copaxone subcutaneous injections three times per week was initiated. Hemifacial spasm has infrequently been reported in the literature as a presenting symptom of Multiple Sclerosis; eye care providers should be congnizant of it's link with neurological disease.


Year: 2015

Program Number: 155096

Resource Type: Scientific Program

Author Affiliation: n/a

Co-Authors: n/a

Co-Author Affiliation: n/a

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