Difference between revisions of "Hemimasticatory spasm"

Secondary hemifacial spasm due to vestibular schwannoma is very rare. The study by S Peker et al.<ref>S Peker, K Ozduman, T Kiliç, M N Pamir. [https://pubmed.ncbi.nlm.nih.gov/15346321/ Relief of hemifacial spasm after radiosurgery for intracanalicular vestibular schwannoma.] Minim Invasive Neurosurg. 2004 Aug;47(4):235-7. doi: 10.1055/s-2004-818485.</ref> was the first reported case of hemifacial spasm responsive to gamma knife radiosurgery in a patient with an intracanalicular vestibular schwannoma. Both spasm resolution and tumor growth control were achieved with a single session of gamma knife radiosurgery. The 49-year-old male patient with a 6-month history of right-sided hearing loss and hemifacial spasm. MRI examination revealed an intracanalicular vestibular schwannoma. The patient was treated with radiosurgery and received 13 Gy at the 50% isodose line. Control of tumor growth was achieved and there was no change in tumor volume at the latest follow-up at 22 months. The hemifacial spasm completely resolved after one year. Surgical removal of the presumably causative mass lesion has been reported to be the only treatment in secondary hemifacial spasm. <blockquote>MRI is the imaging modality of choice and is usually diagnostic in the appropriate clinical setting. The thin T2-weighted 3D CISS axial sequence is important for correct evaluation of the cisternal segment of the nerve. They are usually hypointense on T1, hyperintense on T2 with enhancement after gadolinium. But we cannot be surprised if cases like the one described by Brandon Emilio Bertot et al<ref name=":02">Brandon Emilio Bertot, Melissa Lo Presti, Katie Stormes, Jeffrey S Raskin, Andrew Jea, Daniel Chelius, Sandi Lam. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451153/#!po=12.5000 Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature.]Surg Neurol Int. 2020 Aug 8;11:230. doi: 10.25259/SNI_482_2019.eCollection 2020.</ref> occur. in which a clinical case of a 16-year-old boy with an atypical incidence of a large trigeminal schwannoma presenting with painless malocclusion and unilateral masticatory weakness was presented. This case is the first documented case, to our knowledge, in which a trigeminal schwannoma generated a true malocclusion with masseter weakness and is the 19th documented case of unilateral trigeminal motor neuropathy of various etiology. From a study by Ajay Agarwal,<ref>Ajay Agarwal. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757116/ Intracranial trigeminal schwannoma] Ajay Agarwal. Neuroradiol J.2015 Feb;28(1):36-41. doi: 10.15274/NRJ-2014-10117.</ref> however, it is clear that intracranial trigeminal schwannomas are rare tumors. Patients usually present with symptoms of trigeminal nerve dysfunction, the most common symptom being facial pain. <gallery mode="slideshow" heights="200" caption="Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature">

File:Scwannoma.jpeg|'''Figure 1:''' Preoperative MRI Figure Description: T1-weighted contrast MRI with axial, sagittal, and coronal views of 5.2 × 7.8 × 5.1 cm heterogeneous extra-axial enhancing mass centered in the mesial temporal region left with involvement of the skull base and left foramen ovale, teres and spinosa, encasement and moderate narrowing of the left internal carotid artery, mild obstructive hydrocephalus and marked compression of the brainstem.

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===Multiple sclerosis and trigeminal reflexes===