Bell’s palsy and strokes are completely different diseases that share similar symptoms. Bell’s palsy is frequently confused with strokes. However, it is possible to distinguish between the two when you learn the details.
Over the last 15 years, I have seen several patients that were hospitalized for a possible stroke, only to be discovered to have Bell’s palsy instead. Even health care providers sometimes confuse bell’s palsy with a stroke.
In this article, I will compare and contrast the similarities and differences between Bell’s palsy and a stroke in details. After reading this article, you will be able to differentiate between Bell’s palsy and a stroke if you pay close attention. I will also explain why it is important to distinguish between Bell’s palsy and a stroke.
Similarities between Bell’s palsy and a stroke
At a quick glance, there are some similarities between Bell’s palsy and strokes. Here are those:
- Both Bell’s palsy and strokes make your face distorted
- In both cases, your smile becomes one-sided with the blunting of smile lines (the skin folds that run from the side of the nose to the corner of the mouth) on one side
- Both Bell’s palsy and strokes may make you drool
- In both cases, you have have difficulty eating because of the weakness of the lips and cheek muscles on one side.
This is where the similarity between Bell’s palsy and a stroke ends. If you pay closer attention, you can differentiate between the two.
Here are nine things you need to pay attention to:
- Forehead
- Eyebrows
- Area between the open eyelids
- Vision
- Speech, memory, and attention
- Arms and legs
- Balance
- Coordination
- Walking
We will examine each topic in detail.
Forehead
A stroke does not affect your forehead, but Bell’s palsy frequently does. A person with Bell’s Palsy can not wrinkle their forehead, but a person with a stroke can. This is one of the most important distinguishing features between the two.
Eyebrows
A person with Bell’s palsy cannot raise the eyebrows on the affected side, while a person with a stroke can.
The area between the open eyelids
In patients with a stroke, the area between the open upper and lower eyelids, or simply the open area of the two eyes, remains normal despite the overall droopy appearance of the face. In Bell’s palsy, the open area of the eye on the affected side is widened, and the affected eye looks droopy too.
Vision
The eyes may look droopy and abnormal in Bell’s palsy, but it doesn’t affect vision. If there are any problems such as blurry vision, seeing double, or not seeing on one side, you need to think about a stroke.
Speech, memory, and attention
Despite a droopy face, people with Bell’s palsy are fully awake and can remember things properly. They respond to questions very well, and are fully aware of what’s happening in their surroundings. Due to the weakness of the cheeks on one side, they may have a slightly different voice, but they can talk normally if you give them enough time. If there is anything wrong with their speech, memory, or attention, you need to think about a stroke.
Arms and legs
People with Bell’s palsy never have any problems in their arms and legs as a result of the disease. If they have any asymmetrical weaknesses or numbness in their arms or legs, you need to think about a stroke rather than Bell’s palsy.
Balance
Although your face looks very unbalanced with Bell’s palsy, you don’t have any problems with your actual balance. If someone feels like they are losing balance and getting unsteady along with the droopy face, they need to be worried about a stroke.
Coordination
Despite appearing droopy, your actual hand-eye coordination is perfectly normal with Bell’s palsy. With Bell’s palsy, you never have problems holding a pen, writing, knitting, typing, or any other activity that requires hand-eye coordination. If your movement appears clumsy and uncoordinated, you need to think about a stroke rather than Bell’s palsy.
Walking
People with Bell’s palsy have no problem walking normally. You don’t fall down easily, you don’t drift to one side, you don’t limp or drag one foot. If you have a droopy face and have any problems with walking, you need to think about a stroke.
Here is a table that will summarize the similarities and difference between Bell’s palsy and strokes:
| Signs and symptoms | Bell’s palsy | Stroke |
| Distorted face | Always present | Sometimes present |
| Blunting of smile lines on one side | Always present | Sometimes present |
| Drooling | Always present | Sometimes present |
| Weakness of the lips and cheek muscles on one side. | Always present | Sometimes present |
| Unable to wrinkle the forehead on the affected side | Always present | Mostly absent |
| Unable to raise the eyebrows on the affected side | Always present | Mostly absent |
| Eye opening larger on the affected side | Always present | Mostly absent |
| Problems with vision | Always absent | Sometimes present |
| Problems with speech, memory, and attention | Always absent | Sometimes present |
| Problems with arms or legs | Always absent | Sometimes present |
| Balance problems | Always absent | Sometimes present |
| Problems with hand-eye coordination | Always absent | Sometimes present |
| Problems with walking | Always absent | Sometimes present |
Why is it important to distinguish between Bell’s palsy and a stroke?
Here are several important reasons why you need to distinguish between Bell’s palsy and a stroke:
- Urgency: Strokes are definitely more urgent than Bell’s palsy. If you think you have a stroke, you need to call 911 right away. With a stroke, every second counts. The earlier you arrive in the ER, the better your chances of getting back to normal. Bell’s palsy, on the other hand, doesn’t have the same degree of urgency as a stroke.
- Treatment: The treatment of a stroke is very different from the treatment of Bell’s palsy. If you get to the emergency department in time, you may get clot-busting medications to treat your stroke. These medications may help dissolve the blood clot that caused the stroke and make your symptoms go away. However, you do not want to get these medications with Bell’s palsy, as they can cause life-threatening bleeding. If you arrive in the ER with a droopy face, it is important to distinguish between a stroke and Bell’s palsy right away. It would be disaster to give clot-busting medication by mistake when you simply have Bell’s palsy. The treatment for Bell’s palsy includes some steroids and anti-viral medications. Some patients do better with treatment, but others may not respond to it. Overall, most patients recover from Bell’s palsy, but the time needed to go back to normal varies significantly.
- Hospitalization: If you have a stroke causing a droopy face, you will most likely need hospitalization. Except in a few cases where you can’t swallow properly or are too old or weak to go home, Bell’s palsy doesn’t need hospitalization.
In conclusion, Bell’s palsy is often confused with strokes, but you can differentiate between the two if you pay close attention to the signs and symptoms. It is important to make that distinction, as a stroke needs much more urgent intervention than Bell’s palsy.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150706/