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Most frequently attributed to vascular loop compression at the root exit zone of the facial nerve, there are many other etiologies of unilateral facial movements that must be considered in the differential diagnosis of hemifacial spasm. The primary purpose of this review is to draw attention to the marked heterogeneity of unilateral facial spasms and to focus on clinical characteristics of mimickers of hemifacial spasm and on atypical presentations of nonvascular cases. In addition to a comprehensive review of the literature on hemifacial spasm, medical records and videos of consecutive patients referred to the Movement Disorders Clinic at Baylor College of Medicine for hemifacial spasm between 2000 and 2010 were reviewed, and videos of illustrative cases were edited. Among 215 patients referred for evaluation of hemifacial spasm, 133 (62%) were classified as primary or idiopathic hemifacial spasm (presumably caused by vascular compression of the ipsilateral facial nerve), and 4 (2%) had hereditary hemifacial spasm. Secondary causes were found in 40 patients (19%) and included Bell's palsy (n = 23, 11%), facial nerve injury (n = 13, 6%), demyelination (n = 2), and brain vascular insults (n = 2). There were an additional 38 patients (18%) with hemifacial spasm mimickers classified as psychogenic, tics, dystonia, myoclonus, and hemimasticatory spasm. We concluded that although most cases of hemifacial spasm are idiopathic and probably caused by vascular compression of the facial nerve, other etiologies should be considered in the differential diagnosis, particularly if there are atypical features. \u00a9 2011 Movement Disorder Society<\/jats:p>","DOI":"10.1002\/mds.23692","type":"journal-article","created":{"date-parts":[[2011,4,5]],"date-time":"2011-04-05T17:16:48Z","timestamp":1302023808000},"page":"1582-1592","source":"Crossref","is-referenced-by-count":185,"title":["The many faces of hemifacial spasm: Differential diagnosis of unilateral facial spasms"],"prefix":"10.1002","volume":"26","author":[{"given":"Toby C.","family":"Yaltho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Jankovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,4,5]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199812)21:12<1740::AID-MUS17>3.0.CO;2-V"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22998"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.70.4.516"},{"key":"e_1_2_7_5_2","first-page":"103","article-title":"Etiology and differential diagnosis of blepharospasm and oromandibular dystonia","volume":"49","author":"Jankovic J","year":"1988","journal-title":"Adv Neurol."},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000266389.52843.3b"},{"key":"e_1_2_7_7_2","first-page":"401","article-title":"[Bilateral hemifacial spasm: eight personal case reports]","volume":"35","author":"Llaves\u2010Estevez L","year":"2002","journal-title":"Rev Neurol."},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-282X2003000100023"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870090222"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(199903)14:2<345::AID-MDS1023>3.0.CO;2-1"},{"key":"e_1_2_7_11_2","first-page":"153","article-title":"Bilateral hemifacial spasm","volume":"10","author":"Holds JB","year":"1990","journal-title":"J Clin Neuroophthalmol."},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.65.3.408"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000348548.62440.42"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21202"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2007.06.001"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2004.04.004"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870030211"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410200605"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870010103"},{"key":"e_1_2_7_20_2","first-page":"110","article-title":"Hemimasticatory and hemifacial spasm: a common pathophysiology?","volume":"19","author":"Thompson PD","year":"1983","journal-title":"Clin Exp Neurol."},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20991"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.42.12.2263"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2003.05.005"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-004-0331-5"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880141102"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/107.1.53"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000090041.02085.22"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2006.10.009"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880080702"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181b9c8ce"},{"key":"e_1_2_7_31_2","doi-asserted-by":"crossref","unstructured":"WuY DavidsonA PanT JankovicJ.Asian over\u2010representation among patients with hemifacial spasm. 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