A 62-Year-Old Man With Involuntary Facial Movements

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


April 12, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.