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Hemifacial Spasm

Conflitti Neuro-vascolari

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Definition and Etiology

Neurovascular conflicts include a set of syndromes caused by the compression of cranial nerves, in general in correspondence with their entry point into the brainstem (root entry zone or REZ). 

The REZ is the point in which the sheath (myelin) of central origin (oligodendrocytes) transforms into peripheral myelin (Schwann cells).

Hemifacial spasm is a disorder characterised by a unilateral, involuntary and intermittent contraction of the facial muscles.

The facial nerve controls the muscles of facial expressions (forehead, eye, neck, and cheeks).

Initially, the hemifacial spasm can affect the eyelids with small blinking movements, which can however lead to a more continuous spasm with persistent eye closure. In other cases, the spasm can initiate in the forehead or lower part of the face. A hemifacial spasm starting from the lower part of the face has the distinctive characteristic of deviating the mouth.

Occasionally the spasm can involve the surface muscles on the front of the neck.

The main cause is related to the pulsations of a blood vessel coming into contact with the nerve on the point in which the facial nerve emerges from the brainstem.

The contact (conflict) between the blood vessel and the nerve irritates the latter and determines the spasm.

However, other causes can be a tumor or any other kind of process taking up space close to the nerve or an anomaly in the brainstem.

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