A 62-Year-Old Man With Involuntary Facial Movements

Sumaira Nabi, MBBS; Shahzad Ahmed, MBBS; Mazhar Badshah, MBBS; Ali Nomani, MBBS

Disclosures

April 12, 2016

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Background

A 62-year-old Pakistani man with a medical history of hypertension for 10 years and noncompliance with antihypertensive medication presents with a 1-year history of involuntary movements of the left half of the face. These movements are exaggerated by talking, laughing, and anxiety. These were initially brief and episodic and only involved the ocular muscles.

Three months before presentation, the movements intensified to more sustained tonic contractions involving the entire left half of the face. This is associated with pulsatile tinnitus in the right ear and recurrent episodic vertigo. No history of facial pain, hearing loss, visual impairment, or falls is reported. Past history does not include stroke or transient ischemic attacks. He had been taking enteral baclofen, amlodipine, and betahistine dihydrochloride (an antivertigo drug) for 2 months. He is a nonsmoker and denies substance abuse. He has a strong family history of essential hypertension.

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