Facial myokymia as the presenting symptom of a pontine glioma

Abstract

Facial myokymia (FM) is a rare form of involuntary movement affecting the facial muscles. It is clinically defined as continuous twitching of small bands or strips of muscles that give an undulating or rippling appearance to overlying skin, descriptively called as `bag of worms' appearance. It was first described by Bernhardt in 1902. Initially thought to be characteristic of multiple sclerosis, it was later observed with neoplastic and inflammatory lesions of the brainstem. In long standing cases there in narrowing of palpebral fissure and persistent drawing of angle of mouth called `spastic paretic facial contracture' (SPFC). In this report we describe a case where FM and SPFC were the presenting symptoms of a pontine glioma and emphasize the need to consider an intrinsic brainstem mass in any patient presenting with FM.