Objective: Our aim is to report a case of unusual phenotype of cerebellar ischemic stroke which shows isolated unilateral hemifacial spasm as initial neurological symptoms of cerebellar ischemic stroke.

Background: Hemifacial spasm, or involuntary twitching on one side of the face, can sometimes be caused by a cerebellar ischemic stroke, although it is more commonly due to a blood vessel pressing on the facial nerve. While a stroke in the cerebellar area is a less frequent cause of hemifacial spasm compared to blood vessel compression, it can occur and may also present with other neurological symptoms like balance issues, numbness on one side of the face and body, or trouble swallowing, as is seen in Wallenberg’s syndrome (PICA stroke). Cerebellar ischemic stroke initially presenting as isolated hemifacial spasm without other neurological symptoms and signs extremely rare.

Method: Single case report and description of clinical characteristics.

Results: A 61 years-old woman referred to us due to left hemifacial spasm and twitching symptoms three days ago. She complained only left hemifacial spasm and twitching symptoms without other neurological symptoms and abnormal signs. Diffusion-weighted brain magnetic resonance imaging showed some spotty high signals in the area of left inferior cerebellum. Further neuroradiological studies revealed the existence of poorly delineated left PICA on MRA. Her symptoms were improved by atorvastatin, antiplatelet medication and symptomatic medications including baclofen and clonazepam.

Conclusion: For now, we report for the first time a rare manifestation of cerebellar ischemic stroke initially presenting isolated hemifacial spasm without other neurological symptoms and signs. As like this case, if there are abrupt-onset isolated hemifacial spasm, it should be considered diagnosis of cerebellar ischemic stroke.

References: (Also, this abstract will be presented at International Conference on Alzheimer’s and Parkinson’s Diseases and Related Neurological Disorders: March 17 ADPD 2026)

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-unusual-case-of-cerebellar-ischemic-stroke-initially-presenting-as-isolated-hemifacial-spasm-without-other-neurological-symptoms-and-signs/