hemifacial spasm
Introduction
Introduction to facial muscle spasm Hemifacial spasm, also known as facial muscle twitching or hemifacial spasm. For a condition of involuntary convulsions in the semi-lateral part, the convulsions are paroxysmal and irregular, varying in degree, and may be aggravated by fatigue, mental stress and voluntary movement. The onset begins with the orbicularis muscle and then the entire face. The disease occurs mostly after middle age and is common in women. The cause of this disease is unknown, and modern western medicine still lacks special effects. At present, symptomatic treatment is generally used, but the results are not satisfactory. basic knowledge The proportion of illness: 0.05% - 0.08% Susceptible people: no special people Mode of infection: non-infectious Complications: facial paralysis cerebrospinal fluid leakage
Cause
Hemifacial spasm
Vascular compression factor (30%):
The factors that cause hemifacial spasm are: vascular factors, non-vascular factors, and other factors. Vascular factors are aneurysms that result from the compression of blood vessels in the brainstem area of the facial nerve.
Disease factor (30%):
Secondary symptoms are also called symptomatic hemifacial spasm, and any compression irritant lesion can induce this disease in the entire passage from the cerebral cortex to the peripheral branch of the facial nerve. Clinically common such as middle ear mastoid inflammation and tumors, space-occupying lesions of cerebellopontine angle (cholesteatoma and acoustic neuroma) and encephalitis, arachnoiditis, multiple sclerosis, Paget's disease and cranial depression.
Other factors are (20%):
Facial nerve damage caused by cold or viral invasion of the face.
Prevention
Hemifacial spasm prevention
Idiopathic hemifacial spasm is more common in adults over 40 years old. It may be related to arteriosclerosis and hypertensive disorders. For example, the patient is younger than 30 years old, often suggesting cerebellopontine angle, internal auditory canal, knee joint, middle ear mastoid Or there are neurostimulative lesions in the parotid gland, such as congenital cholesteatoma, hemangioma, acoustic neuroma and arachnoid cyst. It is a dangerous signal of the disease. In case of such a situation, a thorough examination of the nervous system should be performed in time. If necessary, a CT or MRI examination of the brain should be performed, and the waiting can be observed to avoid delay in treatment.
In order to prevent the complications of microvascular decompression surgery, first pay attention to the surgical position, avoid sitting or semi-sitting position, in order to prevent a large amount of air from entering the vein, resulting in multiple organ air embolism, the surgeon should strengthen the basic surgical skills training, open the mastoid The air chamber should be closed in time, skilled use of the aspirator and its pressure adjustment, carefully identify the vascular compression form of the facial nerve out of the brainstem area, avoid blindly electrocoagulation, separate and cut blood vessels, if you can pay attention to the above points, it will be significantly reduced. The occurrence of the disease.
Complication
Hemifacial spasm complications Complications, facial paralysis, cerebrospinal fluid leakage
The hemifacial spasm is slowly progressing, gradually increasing, and generally does not heal. If not given, some patients will have paralysis in the late stage of the disease and convulsions will stop. For patients who have not recovered after several years of attack, they should take active treatment measures to prevent them. The occurrence of facial paralysis, microvascular decompression for patients with hemifacial spasm may have some complications such as hearing loss, facial paralysis and cerebrospinal fluid leakage.
Symptom
Hemifacial spasm symptoms common symptoms can not continue blinking convulsions eating tears facial slamming fatigue nerve pain eyelids jumping nose
Most patients with primary hemifacial spasm develop after middle age, and more women. At the beginning of the course of the disease, the convulsions of one side of the orbicularis muscle are involuntarily involuntarily, and gradually spread to other facial muscles on one side of the face. The twitching of the horn muscles is most noticeable. In severe cases, the ipsilateral platysma can be involved. But the frontal muscles are less involved. The degree of convulsions varies, ranging from paroxysmal, rapid, and irregular convulsions. At the beginning, the convulsions are lighter and last only a few seconds. Afterwards, the gradual length can be ash for a few minutes or longer, and the intermittent time is gradually shortened, and the convulsions are gradually increased.
Severe cases are tonic, so that the ipsilateral eye can not be opened, the mouth angle is skewed to the same side, unable to speak, often exacerbated by fatigue, mental stress, and spontaneous movement, but can not imitate or control its seizure. A convulsion is as short as a few seconds and as long as more than ten minutes. The interval is uncertain. The patient feels upset and unable to work or study, seriously affecting the patient's physical and mental health. Most convulsions stop after falling asleep. Bilateral tendons are rare. If there is, it is often on both sides of the disease, after the side of the convulsions stop, the other side of the attack, and the side of the convulsion is light and heavy on the other side, both sides of the simultaneous onset, while convulsions have not been reported. A small number of patients have mild facial pain during convulsions, and some cases may be accompanied by ipsilateral headache and tinnitus.
Examine
Examination of hemifacial spasm
The examination of hemifacial spasm is mainly for routine electroencephalogram and electromyography. If necessary, mastoid and skull X-ray, head CT and MRI should be performed to exclude mastoid and skull diseases.
Electroencephalogram (EGG) is the spontaneous and rhythmic electrical activity of brain cell populations recorded by electrodes. EEG is the most important screening tool in the diagnosis and treatment of epilepsy. Although high-resolution anatomical and functional imaging is constantly evolving, EEG is always irreplaceable in the diagnosis and treatment of epilepsy.
Head CT is a convenient, rapid, safe, painless, non-invasive new examination method that clearly shows the anatomical relationship of different cross sections of the brain and the specific brain tissue structure. Therefore, the detection rate of the lesion and the accuracy of the diagnosis are greatly improved. In general, CT is better for soft tissue imaging than for soft tissue. Head CT examination is important for the diagnosis of most diseases of the brain, skull, and scalp (including trauma, tumor, inflammation, vascular disease, poisoning, degeneration, and metabolic diseases).
Diagnosis
Hemifacial spasm diagnosis
Clinically, it should be differentiated from the following diseases:
1. Facial paralysis of facial paralysis: In the past, there was a significant history of facial paralysis. Due to the incomplete recovery of facial paralysis, the axonal regeneration was caused by confusion. The affected side left different degrees of facial muscle weakness and paralysis.
2. Idiopathic spasm: bilateral orbital tendon, often accompanied by mental disorders, EMG shows that the facial muscles are not synchronized discharge, the frequency is normal, may be caused by dysfunction of the pyramidal system.
3. Facial muscle twitch: For the facial muscles, individual muscle bundles are slightly vibrating, often invading the surrounding orbital muscles, mostly limited to one side, can be relieved by themselves, may be caused by benign lesions of the brain stem and cranial nerve.
4. Habitual sputum: for small sputum, facial muscles have no purpose stereotypes or repeated beating, more common in one side, mostly in childhood.
5. The movement of the hand and foot caused by lesions in the midbrain and cone system.
