Hemifacial spasm secondary to vascular compression of the facial nerve

Author and Disclosure Information


Idiopathic hemifacial spasm is an uncommon, benign, but distressing condition characterized by the insidious onset of paroxysmal, repetitive, clonic contractions of the facial musculature. The condition usually begins with contractions of the orbicularis oculi and spreads first through contiguous muscles to involve all the muscles innervated by the seventh nerve on one side of the face.1

In a review of 106 cases of cryptogenic hemifacial spasm in 1945, Ehni and Woltman1 pointed out several characteristics of the condition. They found that the disorder occurred only in adults and that the mean age of onset was 45 years, although recently hemifacial spasm has been reported in an 8-year-old child.2 Ehni and Woltman1 observed a sex distribution of six women to four men. Either side of the face was affected in either sex with equal frequency. In six of their patients the spasms were bilateral, but not synchronous nor symmetric. The spasms consisted of intermittent, irregular series of single muscle twitches occurring in rapid sequence. In 12 patients the spasms were observed in sleep.

Psychic upsets, fatigue, and voluntary movement of the face were the most common factors that either precipitated or increased the severity of the spasms. None of the patients could voluntarily stop the spasms, although nine patients experienced periods of spontaneous remission lasting from a few weeks to 3 years. In three patients the spasms were accompanied by trigeminal neuralgia on the ipsilateral side, a condition referred to previously by Cushing3 as “tic convulsif.”

The failure of the spasms. . .



Next Article: