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Introduction

Before getting into the heart of the discussion about the pathology of our patient Mary Poppins, which from the previous chapters seems to be of a neuromotor type, specifically a 'Hemimasticatory Spasm', we must focus on some fundamental points that will help us understand the importance of the excursus of the chapters and at the same time better understand the essence of the process of deciphering the neurological signal, already mentioned several times.

Comencemos diciendo que no es tan complejo hacer un diagnóstico de 'Espasmo Hemimasticatorio', es hacer un diagnóstico diferencial entre Espasmo Hemimasticatorio y Hemifacial porque no depende solo de las zonas nerviosas involucradas, sino que más aún lo es de comprender la naturaleza de la enfermedad para abordar, posteriormente, una terapia adecuada.

First, we must consider movement disorders that can be defined as involuntary or abnormal movements triggered by trauma to the cranial or peripheral nerves or roots... From this it is contextual to consider involuntary movements including spasms also pathologies of the Central Nervous System as well as the peripheral. In a study by Seung Hwan Lee et al. Two vestibular schwannomas, five meningiomas, and two epidermoid tumors were included. Hemifacial spasm occurred on the same side of the lesion in eight patients while it occurred on the opposite side of the lesion in one patient. Regarding the pathogenesis of hemifacial spasms, in six patients the vessels were found to be involved, in one patient the tumor affected the lining of the facial nerve, hypervascular tumor compression of the facial nerve without damage to the vessels in one patient and one patient. Enormous tumor compressing the brainstem thus involving the contralateral facial nerve in another patient. The hemifacial spasm resolved in seven patients, while in two patients with vestibular schwannoma and epidermoid tumor they temporarily improved and then reappeared after a month.

Therefore, contributing causes of the central intracranial type should be taken into account, which could be a contributing cause of facial and/or masticatory spasm, for example, cases of vestibular schwannoma and epidermoid tumors.