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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.<\/jats:p>","DOI":"10.1136\/bcr-2019-231506","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T03:55:43Z","timestamp":1588132543000},"page":"e231506","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Facial twitching: calcium or concussion conundrum? 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