R. NICKBRYANMDS. JAMESZINREICHMD
A 69-YEAR-OLD woman presented with the chief complaint of an embarrassing, involuntary, right-sided facial grimace that occurred intermittently throughout the day. For 7 years, her ophthalmologist had successfully treated her for right blepharospasm with botulinum toxin. However, most recently, she had noted an increase in the frequency and magnitude of her spasms despite alterations in her botulinum toxin injection regimen. Also, her disease had been noted to progress to involve the right buccal and marginal facial nerve branches over the last several months. She denied hearing loss and vertigo; however, she complained of bilateral tinnitus. Her medical history was remarkable for essential hypertension.
Lasak JM, Willcox TO, Rao VM. Imaging Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2000;126(8):1030-1037. doi:10.1001/archotol.126.8.1030