Facial Spasms in a Man Recently Released From the Hospital

Muthunivas Muthuraj; Shailesh Rajguru, DO

Disclosures

May 05, 2022

Physical Examination and Workup

Upon physical examination, the patient appears alert, awake, and oriented. He is not in any distress. His vital signs are:

  • Temperature: 98.0 °F (36.7 °C)

  • Respiration rate: 18 breaths/min, with a peripheral capillary oxygen saturation of 96% on room air

  • Heart rate: 82 beats/min

  • Blood pressure: 108/58 mm Hg

His height is 66.5 in (168.9 cm), weight is 204 lb (92.6 kg), and body mass index is 32.46.

A complete neurologic examination is performed during the visit. The examination begins by assessing the 12 cranial nerves. The pupils are 3 mm, equal, and reactive to light; a direct consensual light reflex is intact bilaterally. Visual fields are full to confrontation. No afferent pupillary defect, internuclear ophthalmoplegia, or nystagmus is noted. No ptosis of the eyelids is noted bilaterally. The face has normal sensation bilaterally, with no underlying facial asymmetry. Hearing is intact to the finger rub test bilaterally. The soft palate elevates symmetrically, and the tongue protrudes in the midline without deviation. A shoulder shrug is symmetric.

The patient does show positive signs of right hemifacial spasms that affect primarily the right orbicularis oculi and right zygomaticus muscle groups. The right palpebral fissure is smaller than the left, secondary to the history of right hemifacial spasms. Extraocular movements of the left eye are full to lateral and downward gaze; however, an impairment of upgaze and medial gaze is noted. Extraocular muscles of the right eye are intact. The patient describes diplopia with binocular vision.

No evidence of head or jaw tremor is noted. Examination of the temporal aspects of the head shows no signs of rigidity of the temporal arteries, which are soft and pulsatile upon palpation bilaterally. Examination of the neck demonstrates full range of motion in all directions, with no dystonic posturing. The patient does not exhibit any cervical paraspinal or trapezius tightness or tenderness. His motor and sensory examinations are normal. He has symmetric deep tendon reflexes throughout.

The results of a noncontrast head CT performed during his recent hospitalization are unremarkable. An example of similar findings is shown in Figure 1.

Figure 1.

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