Hemifacial Spasm Clinical Presentation

Updated: Sep 16, 2019
  • Author: Steven Gulevich, MD; Chief Editor: Nicholas Lorenzo, MD, CPE, MHCM, FAAPL  more...
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Physical Examination

Involuntary facial movement is the only symptom of hemifacial spasm. Fatigue, anxiety, or reading may precipitate the movements. Spontaneous hemifacial spasm manifests with facial spasms that represent myoclonic jerks and are analogous to segmental myoclonus, which may affect other body regions. Postparalytic hemifacial spasm, following facial nerve trauma such as Bell's palsy, manifests as facial synkinesis and contracture.

Physical findings are restricted to the involved facial muscles. The examiner will observe these contracting synkinetically (all at the same time), usually with an irregular frequency. Other neurological findings signal another process elsewhere, or an underlying process such as cerebrovascular disease or multiple sclerosis.  



Prolonged contraction of the orbicularis oculus will result in temporary loss of vision in the involved eye, with impairment of activity.