What is the difference between bells palsy and a stroke

He denies having a headache or any other symptoms. You and your partner promptly load the patient onto your stretcher and expedite transport to the local stroke center. Upon arrival you give a verbal report to the attending physician while the nurse and her team prepare the patient for a CT scan.

Later in the evening you transport another patient to the same ED and inquire about the stroke patient. You feel an immediate sense of frustration. You were confident the patient was having a stroke and wonder if you missed something. Bell later went on to identify several notable connections of the spinal and cranial nerves. Among these findings was that lesion of the seventh cranial nerve results in facial paralysis.

Prevalence increases with age, third-trimester pregnancy and diabetes. Stroke can be a life-threatening condition that requires time-sensitive and invasive treatment regimens. EMTs and paramedics are taught to utilize a stroke scale or other assessment tool when assessing a suspected stroke patient. These tools typically evaluate three areas: facial symmetry, speech and extremity strength.

While tools such as the Cincinnati Prehospital Stroke Scale only require the presence of a single positive finding e. Just as there are risks of undertriage for patients who are potentially experiencing a stroke, potential risks of overtriage include heightened patient anxiety, operational dangers of transport using lights and sirens, and unnecessary use of scarce healthcare resources.

Functions of cranial nerve VII include blinking, smiling, frowning, taste, lacrimation and salivation. The facial nerve traverses the temporal bone through a narrow z-shaped pathway known as the fallopian canal.

Space limitations within this canal mean the section of the facial nerve passing through it is subject to impingement in the presence of inflammation. The nerve becomes edematous secondary to inflammation, which creates a circumferential impingement as it traverses approximately 3 centimeters through the fallopian canal. The circumferential pressure exerted by the edema limits the blood flow, causing the nerve to become ischemic, resulting in unilateral facial paresis or paralysis.

During the secondary assessment, focus your history and physical exam on evaluating specific complaints such as slurred speech or inability to blink.

The provider should examine the area for trauma and complete a detailed neurological assessment. A more detailed cranial nerve assessment may also be included during the secondary assessment see www. Past and current medical histories are also essential in the evaluation process. Patients may need psychological support, especially if speech or facial expressions are altered. Patch the affected eye to protect it from injury and help keep it moist.

Evidence from most studies indicates that the best results are achieved with a combination of corticosteroids, such as prednisone, and an antiviral, such as acyclovir, if started within 72 hours of the onset of symptoms. A review of three randomized, controlled studies of patients receiving corticosteroids alone concluded that corticosteroid treatment did not demonstrate significant improvements in patient outcomes.

As a prehospital care provider, you are likely to encounter a patient who presents with complaints similar to those in the opening scenario. Pay special attention to protecting the affected eye if the patient is unable to blink and providing the patient with reassurance. Gilden DH. Clinical practice. N Eng J Med, Sep 23; 13 : 1,— Ahmed A. When is facial paralysis Bell palsy?

Current diagnosis and treatment. Cleve Clin J Med, May; 72 5 : —, Holten KB. J Fam Pract, Oct; 53 10 : —8. Carlson DS, Pfadt E. When your patient has acute facial paralysis. Nursing, Apr; 35 4 : 54— Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med, Apr; 33 4 : —8. Nurse Pract, Apr; 30 4 : 58— Patel AA. Facial Nerve Anatomy. Gilbert SC. Herpes, Dec; 9 3 : 70—3. National Institute of Allergy and Infectious Diseases. Ronthal M.

While Bell's palsy does not involve brain function, it is totally possible for a stroke to only involve facial nerve function.

Since a stroke has the potential to involve the area of the brain where the facial nerve originates, the only way to tell for sure what is causing the facial droop is to see your healthcare provider immediately or go to the emergency room at a hospital to be diagnosed. A condition that mimics a stroke like Bell's palsy is a condition that has similar signs and symptoms as strokes, such as those described below. The seizure disorder epilepsy was the most common stroke mimic seen in one study of patients in the emergency department.

Sometimes, seizures can cause neurological signs and symptoms that mimic strokes, without the typical convulsions. Hypoglycemia low blood sugar was the third most common stroke mimic seen in the emergency department in the same study. Low blood sugar, particularly in patients with diabetes who are being treated with insulin, can lead to a transient loss of neurologic function.

Patients with a history of transient ischemic attacks are especially likely to show signs and symptoms indicative of strokes when experiencing hypoglycemia. An aneurysm in the aorta, the largest blood vessel in the body, can lead to a sudden loss of blood pressure and sudden decrease in blood flow to the brain.

The decreased blood flow can cause the brain to exhibit similar signs and symptoms to a stroke. Aortic dissection was the stroke mimic most likely to be fatal. A sudden loss of consciousness from a drop in blood pressure is called syncope.

The most common causes are cardiac conditions and vagus nerve stimulation. Due to the fact that syncope is essentially a brain malfunction, the potential for confusion between syncope and stroke can occur. A systemic infection that affects multiple body systems is known as sepsis. Sepsis is a complicated condition that can mimic stroke through confusion, dizziness, loss of coordination or balance, headache, and other symptoms.

The second most common stroke mimic identified in the same study was a psychiatric diagnosis. This is such a broad category that it is impossible to narrow down a single type of psychiatric diagnosis as the only cause. Blood pressure is a good indicator of stroke when paired with other stroke symptoms like difficulty speaking, facial droop, weakness on one side, among others.

If a patient was not already feeling sick prior to the onset of symptoms, there is a higher probability that the sudden symptoms indicate a stroke. Patients who were feeling sick prior to the onset of symptoms could have a different condition. The healthcare provider in the emergency department will need to rule out other potential causes in order to properly diagnose stroke.

The older a patient is, the more likely he or she is experiencing a stroke with the symptoms listed above. Since a stroke can happen with any or all of these symptoms discussed, it is nearly impossible to differentiate between a stroke and any of the mimic conditions, including Bell's palsy, without seeing your healthcare provider or going to the emergency room. Patients presenting with a possible stroke will generally undergo several tests to determine if the symptoms come from a stroke or not.

Bell's palsy and strokes are two conditions that have the potential to share similar signs and symptoms, including facial droop. If you are experiencing facial droop or any stroke symptoms , it is best to seek help immediately for appropriate diagnosis and treatment.

Strokes can cause increasing brain damage and disability the longer treatment is delayed, so it is best to seek help as soon as possible. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Centers for Disease Control and Prevention. Stroke signs and symptoms. Last reviewed August 28, The neurologist's dilemma: A comprehensive clinical review of Bell's palsy, with emphasis on current management trends.

Med Sci Monit. Bell's palsy: Symptoms preceding and accompanying the facial paresis. Scientific World Journal. Also, because symptoms can mimic stroke, it is important to have the condition evaluated.

If you experience facial drooping or weakness, visit your nearest emergency department to rule out stroke. Schedule an appointment with Dr. Jani or one of our other primary care providers. Save time, book online. Need to make an appointment with a Piedmont physician? Close X. Back to Living Better Living Better newsletter.