History: The patient is a 29-year-old female from Addis Ababa, Ethiopia. She presented to one of the private clinics in Addis Ababa on April 16, 2012, with a complaint of left hemifacial hyperhidrosis of 8 years which worsen after routine household activities and exercise. Associated with this she also had pain and numbness in the left upper limb. Otherwise, there was no personal or family history of diabetes or other chronic illness. She had no history of surgery, trauma, and skin rash. Physical examination: The patient's vital signs were normal. The general systemic examinations were normal, and there were no signs of a change in skin color. The patient was alert and oriented with fluent language and intact comprehension. Cranial nerves were normal except for the presence of left hemifacial hyperhidrosis with right hemifacial anhidrosis (). Muscle bulk, tone, and muscle power were normal with normal deep tendon reflex. The plantar responses were down-going bilaterally. Sensation was intact for light touch, pinprick, vibration, and position throughout. No coordination abnormalities were detected. Meningeal irritation signs were also negative. Auxiliary examinations: Her complete blood count, erythrocyte sedimentation rate, liver function test, lipid profile, renal function test, and plasma glucose levels were normal. Serum VDRL, Rheumatoid factor, and C-reactive protein results were non-reactive; HBsAg and anti-HCV antibodies and serology for retroviral infections were all negative. The nerve conduction study of the upper and lower limbs was also normal. The brain MRI result was normal. Cervical and upper thoracic MRI results suggested normal findings, except for the presence of C4-5, C5-6, and C6-7 mild anterior thecal indentation by bulged discs (). The course of treatment: She was given Glycopyrrolate topical cream which showed no significant improvement and the patient was counseled on the disease entity. The patient was on follow-up for 10 years with no significant worsening or improvement of symptoms.