Progressive facial hemiatrophy revisited: a role for sympathetic dysfunction.

OBJECTIVE To report a case of progressive facial hemiatrophy with unusual features of contralateral brain atrophy and transcranial Doppler ultrasound evidence of autonomic dysfunction. DESIGN Case report. SETTING A teaching hospital. PATIENT A 63-year-old man who presented with a 10-year history of progressive right-sided facial atrophy and recent facial pain. RESULTS Brain magnetic resonance imaging revealed left frontoparietal atrophy. Transcranial Doppler ultrasound demonstrated evidence of autonomic dysfunction ipsilateral to brain atrophy. CONCLUSION This case expands the spectrum of findings in progressive facial hemiatrophy to include contralateral brain atrophy and suggests that sympathetic dysfunction might play a pathogenic role in progressive facial hemiatrophy.