Hyperglycemic hemifacial spasm: A case report

Hemifacial spasm (HFS) is a movement disorder characterized by either brief or persistent, intermittent twitching of the muscles innervated by the facial nerve, commonly resulting from compression of the seventh cranial nerve and also can be secondary to abnormal metabolic conditions.1 The most commonly reported and bestrecognized movement disorder secondary to hyperglycemia is hemichorea.2 In this study, we report an unusual case presenting with hemifacial spasm as the initial manifestation of uncontrolled hyperglycemia, which resolved rapidly following the correction of hyperglycemia. This case broadens our understanding of movement disorders associated with hyperglycemia. This study followed the tenets of the Declaration of Helsinki, and was performed according to the guidelines of the Second Affiliated Hospital of Zhejiang University School of Medicine. Written informed consents were obtained from the patient.


| INTRODUC TI ON
Hemifacial spasm (HFS) is a movement disorder characterized by either brief or persistent, intermittent twitching of the muscles innervated by the facial nerve, commonly resulting from compression of the seventh cranial nerve and also can be secondary to abnormal metabolic conditions. 1 The most commonly reported and best-recognized movement disorder secondary to hyperglycemia is hemichorea. 2 In this study, we report an unusual case presenting with hemifacial spasm as the initial manifestation of uncontrolled hyperglycemia, which resolved rapidly following the correction of hyperglycemia. This case broadens our understanding of movement disorders associated with hyperglycemia.
This study followed the tenets of the Declaration of Helsinki, and was performed according to the guidelines of the Second Affiliated Hospital of Zhejiang University School of Medicine. Written informed consents were obtained from the patient.

| C A S E REP ORT
A 46-year-old male patient was referred to our neurology department due to a 9-day history of involuntary contractions of his left facial expression muscles, involving both the upper and lower face (Video S1). Each episode lasted less than a minute and occurred multiple times per day, particularly during speaking and eating.
The patient was alert during episodes. The symptom disappeared during sleep, and no other conditions such as involuntary movement of the limbs, dizziness, slurred speech, limb weakness, and double vision were present. He had been medicated with baclofen, vitamin B12, vitamin B1, and oxcarbazepine on the fourth day after the symptom onset in another hospital, but with no relief. His prior medical history was unremarkable. On neurological examination, he was fully alert and oriented, and no other signs were observed except for episodes of hemifacial spasm. CT scan of the brain and After admission, the patient's blood glucose levels were controlled with insulin (Table 1). Oral hypoglycemic drugs including metformin, acarbose, and gliclazide were also prescribed during the following days. A rapid improvement of the patient's symptom was observed after blood glucose normalization on the second In the current study, we report a case presenting with hemifacial spasm as the initial manifestation of diabetes, which completely resolved after glycemic control. To the best of our knowledge, we are the first to report a case of hemifacial spasm associated with nonketotic hyperglycemia, indicating the necessity to consider hyperglycemia as a differential diagnosis for hemifacial spasm. The underlying pathophysiological mechanisms are elusive, which need further investigation.

K E Y WO R DS
blepharospasm, differential diagnosis, hemifacial spasm, hyperglycemic, MRI

ACK N OWLED G M ENTS
We would like to thank the patient and his families for agreeing to provide medical records and videos.

CO N FLI C T O F I NTE R E S T S
Dr. Chen, Luhang Jin, Yuyu Xu, Zheyu Li, Dr. Zhang and Dr. Gao reports no disclosures.

AUTH O R CO NTR I B UTI O N S
Yanxing Chen, Luhang Jin: Analyzed and interpreted the data and wrote the manuscript. Yuyu Xu and Zheyu Li: Analyzed and interpreted the data. Baorong Zhang: Designed and interpreted the data. Feng Gao: Designed and interpreted the data, revised the manuscript.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.