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A 23-year-old right-handed Caucasian woman presented with a 2-week history of continuous facial myokymia. This had begun in the left periorbital region, spreading to involve the entire left face, accompanied by left hemifacial spasms. It increased in intensity and subsequently spread to the right periorbital and perioral region, continuing during both when awake and asleep. She was otherwise well, taking no medications and with no significant family or travel history.
On examination, there were continuous high-frequency, low-amplitude facial twitching, consistent with continuous facial myokymia (see online supplemental video), which was more marked and appeared to be of higher frequency on the left side of the face than on the right. She had left hemifacial spasm, characterised by upward distortion of the left side of her mouth (activation of zygomaticus major) and a left pseudoptosis (activation of orbicularis oculi) (figure 1). Examination of the cranial nerves, limbs and …
Contributors A-MCP authored the manuscript, prepared the images and liaised with the patient to obtain consent. JB took the patient video, assisted with the patient's clinical care and revised the manuscript. ES revised the manuscript and was the consultant responsible for the patient's clinical care.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Helen Ford, Leeds, UK.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.