Facial twitching: calcium or concussion conundrum? Hypocalcaemia in a young American football player masking an internal carotid artery dissection
Muthalagappan, Seethalakshmi Robbins, Timothy Mehta, Hiten Murthy, Narasimha
Muthalagappan, Seethalakshmi
Robbins, Timothy
Mehta, Hiten
Murthy, Narasimha
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Affiliation
South Warwickshire University NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust
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Publication date
2020-04
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Research Projects
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Abstract
A 30-year-old male American football player presented to the acute medical unit with left-hand and hemifacial spasms. History and examination revealed hemifacial spasms in keeping with seizure-like activity possibly due to symptomatic hypocalcaemia. Subsequent investigations revealed an adjusted calcium of 1.87 mmol/L and, hence, he was managed with intravenous calcium replacement. He presented two further times in a 1-month period, with subjective limb weakness, despite normal adjusted calcium. During his third admission, he developed slurred speech and a marked facial droop, with absence of power in the right upper limb. Imaging revealed acute and old infarctions in the left middle cerebral artery territory and appearances consistent with left internal carotid artery dissection. This presentation of arterial stroke is atypical but with potentially grave consequences if missed. There is limited literature on the presentation of hemifacial spasm, and its association with ischaemic or haemorrhagic stroke represents a key learning point.
Keywords: calcium and bone; stroke.
Citation
Muthalagappan S, Robbins T, Mehta H, Murthy N. Facial twitching: calcium or concussion conundrum? Hypocalcaemia in a young American football player masking an internal carotid artery dissection. BMJ Case Rep. 2020 Apr 28;13(4):e231506. doi: 10.1136/bcr-2019-231506.
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Report