Ever Seen a Positive Chvostek Sign? Unbelievable!

Consent was taken from the patient for the use of video for educational purposes.

The patient was 45 y/f status post total parathyroidectomy for parathyroid adenoma. She had positive chvostek sign post-surgery including other signs of hypocalcemia.

Thank you Dr. Suraj Gupta for demonstrating the Chvostek sign.

What is the Chvostek sign?
The Chvostek sign is a clinical finding associated with hypocalcemia or low levels of calcium in the blood. This clinical sign refers to a twitch of the facial muscles that occurs when gently tapping an individual's cheek, in front of the ear. The Chvostek sign aims to elicit an atypical reaction of the facial nerve, the nerve that innervates many of the muscles of the face. The pressure caused by the tapping acts as a triggering stimulus for involuntary contractions of the facial muscles ipsilaterally, or on the side where the clinical sign is performed. The sign is considered negative when no contractions of the facial muscles occur after stimulation of the facial nerve.

Ionized calcium, or Ca+2, is responsible for controlling the neuron’s threshold potential, which is the critical point before the neuron activates. Hypocalcemia, or an atypically low level of calcium in an individual’s blood, decreases the threshold needed for the neuron to transmit a signal to the muscle. Therefore, low calcium levels result in hyperexcitability of the nerves, which can result in spontaneous twitches, as seen with a positive Chvostek sign.
How is the Chvostek sign performed?
The Chvostek sign is performed by gently tapping the individual’s cheek 2 centimeters (about 0.75 inches) in front of the ear, over the route of the facial nerve, also known as the seventh cranial nerve (CN VII). Twitching of the mouth and periorbital muscles, or muscles around the eyes, on the same side as the stimulated facial nerve, is considered a positive Chvostek sign.

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[surajgupta]

Wow. Very informative nad useful video. 👏👏