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.