A sudden facial droop might not be what you think. Knowing the difference between a stroke and Bell’s palsy, a temporary facial paralysis, could save precious time when seconds count.
What is a stroke?
A stroke occurs when blood flow is interrupted to part of the brain, causing brain cells to die from a lack of oxygen. Many people misunderstand what a stroke might look like, however.
“Strokes are not all the same, with just weakness on one side of the body,” said Andrew D. Barreto, MD, a vascular neurologist at UTHealth Houston Neurosciences Neurology — Texas Medical Center and professor of neurology at McGovern Medical School at UTHealth Houston. “Strokes can present as a sudden onset of speaking problems alone, such as slurred or confused speech.”
People experiencing a stroke might also have trouble with dizziness, walking, feeling one side of their body, or sudden double vision or loss of vision on one side. Barreto said that suddenly experiencing the worst headache of your life may indicate a hemorrhagic stroke, which occurs when a blood vessel ruptures and bleeds into the brain.
“We have emergency treatments that can reverse stroke symptoms if given early enough,” Barreto said. “Never delay in calling 911 if you suspect a stroke. If you wait too long to see if symptoms improve, it may be too late to receive treatment, and the symptoms could be permanent.”
Remember the FAST tips (face drooping, arm weakness, speech difficulty, and time to call 911) to recognize a stroke and seek emergency care.
What is Bell’s palsy?
Bell’s palsy is a condition that can cause sudden weakness or paralysis of one half of the face, which often leads people to think they’re having a stroke. It’s most common between the ages of 10 and 40, according to the American Academy of Otolaryngology – Head and Neck Surgery. It usually affects the forehead, lower face, cheeks, and mouth.
“Bell’s palsy is a common stroke mimic as the facial droop can be dramatic, causing patients to become frightened,” Barreto said. “An important difference is that Bell’s palsy will not cause loss of sensation or numbness on the side of the face.”
Making a diagnosis
Understanding the key differences between Bell’s palsy and a stroke is essential. It can save time in an emergency when someone is having a stroke. It can also help avoid misdiagnosing Bell’s palsy as an acute stroke.
When patients present with facial weakness, Barreto said doctors primarily rely on the clinical exam and symptoms to distinguish between the two. Bell’s palsy patients will have trouble closing their eyelids and can sometimes have eye redness and tearing, as the eye’s surface dries out. Bell’s palsy can also impact hearing or the ability to taste. Barreto said that a brain MRI may be necessary to rule out a stroke, since brain damage is visible on MRIs.
Pursuing treatment and recovery
Anti-inflammatory medications are the hallmark for treating Bell’s palsy since the facial nerve is inflamed. Physicians will prescribe a few weeks of steroids. Treatment also includes applying artificial tears so the eye doesn’t dry out and cause an ulcer, which could damage vision long term. Wearing an eye patch when sleeping is also important.
There’s generally positive news for those diagnosed with Bell’s palsy. Barreto said every patient will improve to some degree. In fact, more than 80% will recover completely, usually within a few weeks to a few months. After six months, the facial asymmetry usually will remain permanent if it hasn’t improved.
Unfortunately, stroke patients don’t recover as quickly or completely as Bell’s palsy patients, especially those with severe symptoms.
While both conditions can be concerning, their preventability differs significantly. The majority of strokes are preventable by not smoking and controlling risk factors such as hypertension, diabetes, and high cholesterol. While Bell’s palsy is associated with diabetes, obesity, and hypertension, there are no clear ways to prevent it.
Managing the emotional perspective
The emotional toll of these conditions shouldn’t be overlooked. Barreto said patients with Bell’s palsy often say they feel disfigured, which can cause anxiety, especially in social situations.
“Luckily, contrary to many stroke victims, this does not lead to disability and the inability to return to work or hobbies,” he said.
Stroke patients, however, can develop severe depression due to brain damage, which can further limit their return to activities of daily living.
Understanding the differences between strokes and Bell’s palsy empowers you to act decisively in an emergency, potentially saving a life or preserving someone’s quality of life.
