From the Research
Soaring of the forehead muscles in stroke symptoms suggests a lower motor neuron facial weakness rather than an upper motor neuron lesion typically seen in stroke. This distinction is crucial because in a true stroke, the forehead muscles are usually spared due to bilateral cortical innervation of the upper face 1. When a patient can still wrinkle their forehead or raise their eyebrows despite having facial weakness in the lower face, it points to an upper motor neuron lesion consistent with stroke. Conversely, if the forehead muscles are affected (cannot wrinkle forehead), this suggests a peripheral facial nerve problem like Bell's palsy rather than a stroke. The provided evidence on migraine and headache disorders 2, 1, 3, 4, 5 does not directly address the specific question of forehead muscle soaring in stroke symptoms, but it highlights the importance of accurate diagnosis and treatment of various headache disorders.
Key points to consider in this scenario include:
- The difference in innervation of the upper and lower face, with the upper face receiving bilateral cortical input and the lower face receiving only contralateral input 1
- The distinction between upper and lower motor neuron lesions, with upper motor neuron lesions typically sparing the forehead and lower motor neuron lesions affecting the entire side of the face, including the forehead
- The importance of a comprehensive evaluation to rule out underlying disorders that can be associated with high mortality and morbidity, such as subarachnoid hemorrhage and reversible cerebral vasoconstriction syndrome 4
In clinical practice, it is essential to prioritize the patient's morbidity, mortality, and quality of life when making diagnostic and treatment decisions. In this case, accurately identifying the type of facial weakness is critical to determining the underlying cause and guiding appropriate treatment.