From the Guidelines
Stroke and Bell's palsy are distinct neurological conditions with different causes, symptoms, and treatments, and the key distinguishing feature is that stroke affects multiple body functions and is a medical emergency, while Bell's palsy is limited to facial muscles and is not life-threatening. A stroke occurs when blood flow to the brain is interrupted, either by a blockage (ischemic stroke) or bleeding (hemorrhagic stroke), causing brain cells to die and resulting in sudden weakness or paralysis that typically affects one entire side of the body. In contrast, Bell's palsy specifically affects the facial nerve (cranial nerve VII), causing sudden weakness or paralysis of facial muscles on one side only, as defined by the clinical practice guideline: Bell's palsy executive summary 1. Bell's palsy patients typically experience drooping of one side of the face, difficulty closing the eye, drooling, and altered taste, but no other neurological deficits, and may also experience dryness of the eye or mouth, taste disturbance or loss, hyperacusis, and sagging of the eyelid or corner of the mouth, as noted in the study 1. The treatment for Bell's palsy often includes oral corticosteroids like prednisone, and most patients recover completely within 3-6 months without intervention, with approximately 70% of patients with complete paralysis and as high as 94% of patients with incomplete paralysis recovering completely within 6 months, as reported in the study 1. Some key differences between stroke and Bell's palsy include:
- The area of the body affected: stroke can affect multiple body functions, while Bell's palsy is limited to facial muscles
- The severity of the condition: stroke is a medical emergency, while Bell's palsy is not life-threatening
- The treatment: stroke often requires immediate emergency treatment with medications like tissue plasminogen activator (tPA), while Bell's palsy is often treated with oral corticosteroids like prednisone. It is essential to note that Bell's palsy is a diagnosis of exclusion, requiring the careful elimination of other causes of facial paresis or paralysis, as emphasized in the guideline 1. Overall, while both conditions can cause sudden weakness or paralysis, the key differences in symptoms, treatment, and severity make it crucial to accurately diagnose and treat each condition promptly.
From the Research
Difference between Cerebrovascular Accident (CVA) or Stroke and Bell's Palsy
- A cerebrovascular accident (CVA) or stroke occurs when the blood supply to the brain is interrupted, either due to a blockage or rupture of blood vessels, leading to tissue damage and loss of brain function [no relevant studies provided].
- Bell's palsy, on the other hand, is a condition characterized by facial paralysis, which is typically unilateral and affects the lower motor neuron of the facial nerve 2, 3, 4, 5, 6.
Key Characteristics of Bell's Palsy
- Acute onset of unilateral facial weakness or paralysis involving the forehead 3, 4.
- Absence of other neurologic abnormalities 2, 3, 4.
- Idiopathic, with possible etiology linked to infection with herpes simplex virus type 1 3.
- Symptoms typically peak in the first week and then gradually resolve over three weeks to three months 3.
Treatment and Prognosis of Bell's Palsy
- Corticosteroids are the mainstay of treatment and should be initiated within 72 hours of symptom onset 2, 4, 5.
- Antiviral therapy in combination with corticosteroid therapy may confer a small benefit 2, 3, 4, 5.
- Approximately 70 to 80 percent of patients will recover spontaneously, with more than two-thirds of patients with typical Bell's palsy having a complete spontaneous recovery 3, 4.