Compression of cranial nerves by tumours or aneurisms of the base has
been the cause of symptoms imagined to be identical with those of tic.
The case of intracranial neoplasm mentioned by Oppenheim, in which
irritation of the upper branch of the trigeminal was accompanied by
homolateral facial contraction, is wholly comparable to the so-called
"tic douloureux."
No less positive is our refusal to accept as tics spasmodic
contractions in association with or subsequent to facial palsy or
contracture of peripheral or central origin. They are spasms, not tics.
Cruchet, for instance, describes indifferently as labial tic or
intermittent labial hemispasm clonic elevation or depression of the oral
aperture developing in central facial paralysis, especially in children.
As example he refers to the case of a child in whom an ictus at the age
of three years was followed by a typical spastic hemiplegia on the left
side, with athetoido-choreic movements chiefly in the arm.
At first the left side of the face was flaccid and deviated in the
other direction, but at the time of examination it presented no
unusual feature beyond a continual twitching, a real convulsive
tic, of the upper lip.
Now, whatever a facial convulsion of apoplectic origin, secondary to
facial palsy and accompanied with spastic hemiplegia and athetosis, may
be, it is at all events no tic.
Take one more case, given by Buss[45] as "convulsive tic of the left
side of the face."
The patient was an atheromatous subject, with cardiac hypertrophy,
bronchitis, and emphysema. When he first came under observation at
the hospital, his eyelids, cheek, and buccal commissure were the
seat of painless clonic contractions, which a month later were
complicated by giddiness, vomiting, inability to stand or walk,
lancinating pain over the right side of the face, weakness of the
right limbs, and left facial paresis, and had become fugitive and
insignificant. Loss of consciousness was followed by flaccidity of
all four extremities, hyperpyrexia, and death. The section showed a
hæmorrhage of the dimensions of a pigeon's egg which had destroyed
the left half of the pons, and an atheromatous dilatation of the
left posterior cerebellar artery, impinging at one spot on the
seventh and eighth nerves of the same side. Microscopical
examination of their trunks and of the facial area in the pons
disclosed no abnormality.
The pathological anatomy of this case indicates its nature unmistakably,
and its symptomatology and evolution, moreover, do not bear the
remotest resemblance to those of tic.
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