LAUSR

In “Teaching Video NeuroImage: Bilateral Hemifacial Spasm in Giant Cell Arteritis,” Sechi et al. presented a video of bilateral hemifacial spasm in a patient with giant cell arteritis complicated by supratentorial infarcts. They attributed the facial contractions to facial nerve irritation. However, because the orbicularis and frontalis contraction occurred bilaterally and simultaneously, Cornblath and Eggenberger suggested it appeared to be centrally mediated and proposed it could be an epileptic phenomenon associated with the supratentorial infarcts. Sechi et al. responded that their patient (1) had asymmetric cheek movements characteristic of bilateral hemifacial spasm; (2) had exclusive involvement of upper facial muscles, consistent with peripheral irritation of the superior branch of the facial nerve; (3) improved with steroids (and was not given antiepileptic drugs); (4) had a normal EEG (although this was performed after the resolution of the facial contractions); and (5) had no recurrence of facial contractions in the subsequent 4 years. While it seems unlikely that the superior branches of the facial nerve would simultaneously be activated bilaterally, the rapid resolution and absence of recurrence of this patient's bilateral hemifacial spasm makes the etiology unclear.