Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis

An 80-year-old man developed bitemporal headache and scalp tenderness. Both temporal arteries were prominent (Figure, A), with halo sign on ultrasonography.1 Temporal arteritis was diagnosed and oral prednisone (50 mg/d) initiated. Three days later, he developed spasms of the orbicularis oculi and frontalis muscles with eyebrow elevation and eye twitching (other Babinski sign),2 consistent with bilateral hemifacial spasm (Video 1). Brain MRI and time-of-flight angiography revealed exclusively supratentorial acute infarcts (Figure, B and C) without intracranial neurovascular conflicts. Intravenous methylprednisolone (1 g/d for 5 days) was started with resolution of spasms within 24 hours and clinical stabilization. Temporal artery inflammation may cause facial nerve irritation and hemifacial spasm (Figure, D).

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