Contributions
Abstract: EP1373
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Introduction: Involuntary facial movements including continuous facial myokymia (CFM) and hemifacial spasm (HFS) are rare clinical manifestations of multiple Sclerosis (MS). CFM is characterised by rhythmic, vermiform movement of unilateral facial musculature with MS being the most common aetiology. Meanwhile, HFS presents with irregular, synchronous unilateral tonic or clonic facial muscle contractions which is very rarely associated with MS. We present three patients with abnormal facial movements at initial neurology review who were subsequently diagnosed with MS.
Case 1: 37-year-old man presenting after two months of diverse focal neurological symptoms. Left sided CFM noted on examination. MRI showed florid T2 lesions in brain, brainstem (left midbrain/pons) and spinal cord with multiple contrast enhancing lesions.
Case 2: 46-year-old woman presenting with right sided CFM. She had a previous episode of transient right leg numbness. MRI showed multiple T2 lesions in the brain and spinal cord but none involving the brainstem (previously presented at the Association of British Neurologists conference 2017).
Case 3: 47-year-old man presented with HFS recorded by patient on video which spontaneously resolved. MRI showed one subcortical and two periventricular T2 lesions but no brainstem lesion. He declined investigation at this point. Six years later he developed an ataxic gait and MRI showed progression.
All patients fulfilled the 2010 Revised McDonald Criteria for a diagnosis of MS.
Discussion: There are only 2 case reports of CFM and 1 case report of HFS as the presenting symptom of MS in the literature. CFM is usually associated with an ipsilateral lateral pontine lesion on MRI. Only one of the two patients demonstrated this lesion. HFS is commonly attributed to a vascular compression of the facial nerve. However, in MS, an ipsilateral facial nucleus lesion has occasionally been described although not in our case.
Although MS presenting with HFS or CFM is rare, knowledge of the association is essential to enable timely diagnosis. These cases also demonstrate that typical MRI lesions may be absent.
Disclosure: Oliver Cousins: Nothing to disclose
S Harikrishnan: Nothing to disclose
Yoshua Collins-Sawaragi: Nothing to disclose
Abstract: EP1373
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Introduction: Involuntary facial movements including continuous facial myokymia (CFM) and hemifacial spasm (HFS) are rare clinical manifestations of multiple Sclerosis (MS). CFM is characterised by rhythmic, vermiform movement of unilateral facial musculature with MS being the most common aetiology. Meanwhile, HFS presents with irregular, synchronous unilateral tonic or clonic facial muscle contractions which is very rarely associated with MS. We present three patients with abnormal facial movements at initial neurology review who were subsequently diagnosed with MS.
Case 1: 37-year-old man presenting after two months of diverse focal neurological symptoms. Left sided CFM noted on examination. MRI showed florid T2 lesions in brain, brainstem (left midbrain/pons) and spinal cord with multiple contrast enhancing lesions.
Case 2: 46-year-old woman presenting with right sided CFM. She had a previous episode of transient right leg numbness. MRI showed multiple T2 lesions in the brain and spinal cord but none involving the brainstem (previously presented at the Association of British Neurologists conference 2017).
Case 3: 47-year-old man presented with HFS recorded by patient on video which spontaneously resolved. MRI showed one subcortical and two periventricular T2 lesions but no brainstem lesion. He declined investigation at this point. Six years later he developed an ataxic gait and MRI showed progression.
All patients fulfilled the 2010 Revised McDonald Criteria for a diagnosis of MS.
Discussion: There are only 2 case reports of CFM and 1 case report of HFS as the presenting symptom of MS in the literature. CFM is usually associated with an ipsilateral lateral pontine lesion on MRI. Only one of the two patients demonstrated this lesion. HFS is commonly attributed to a vascular compression of the facial nerve. However, in MS, an ipsilateral facial nucleus lesion has occasionally been described although not in our case.
Although MS presenting with HFS or CFM is rare, knowledge of the association is essential to enable timely diagnosis. These cases also demonstrate that typical MRI lesions may be absent.
Disclosure: Oliver Cousins: Nothing to disclose
S Harikrishnan: Nothing to disclose
Yoshua Collins-Sawaragi: Nothing to disclose