From the Guidelines
Yes, a stroke can cause only right facial droop, as damage to the left side of the brain, specifically in the facial motor cortex or the nerve pathways that control facial movements, can result in this presentation. This typically occurs due to the crossing of nerve fibers from one side of the brain to the opposite side of the body, leading to central facial palsy, where the lower part of the face is predominantly affected while the forehead muscles may be relatively spared 1. According to the most recent guidelines, a stroke can present with sudden numbness or weakness of the face, arm, or leg, especially on one side of the body, and facial droop is a key assessment point in the NIH Stroke Scale 1.
Key Considerations
- The facial nerve (CN VII) is complex and contains branchial motor, visceral motor, general sensory, and special sensory functions, making it susceptible to various types of damage 1.
- Peripheral, nuclear, or infranuclear facial nerve paralysis can present as ipsilateral facial paralysis with involvement of the forehead, and can result from pathology affecting the facial nerve nucleus or any portion of the facial nerve after exiting the brainstem 1.
- Rarely, brainstem or cortical infarct can result in an isolated facial nerve palsy, emphasizing the importance of prompt evaluation and treatment 1.
Clinical Implications
- A right facial droop may be the only visible symptom of a stroke, but patients should be evaluated immediately as other subtle neurological deficits might be present 1.
- Timely treatment significantly improves outcomes in stroke patients, making it essential to recognize the signs and symptoms of stroke and activate the EMS system promptly 1.
- The combination of poor perfusion and hypoxemia can exacerbate and extend ischemic brain injury, leading to worse outcomes, highlighting the importance of supplementary oxygen administration to hypoxemic stroke patients 1.
From the Research
Stroke and Facial Droop
- A stroke can cause facial droop, but it is not limited to only one side of the face 2.
- The presentation of stroke can vary, and it may cause peripheral type facial palsy, which can be mistaken for other conditions 3.
- Facial paresis after stroke can impact patients' facial movement and mental status, and orofacial therapy can improve facial movement and mental state in patients with stroke 4.
Causes of Facial Droop in Stroke
- Stroke can cause facial droop due to the involvement of the cranial nerves' cortical representation areas, central nervous system pathways, or motoneuron pools 5.
- Facial asymmetry is common in stroke patients, but it can be discrete, and lip restraining forces can be reduced 5.
- The cause of facial droop in stroke can be due to ischemic or hemorrhagic stroke, and it can be related to various risk factors, disease processes, and mechanisms 2.
Specific Cases of Stroke and Facial Droop
- A case report of a pediatric stroke presented with left facial droop and hemiparesis, which was believed to have been caused by a recent traumatic clavicular injury 6.
- This case highlights the importance of evaluating pediatric patients with a high index of suspicion for stroke, even in the absence of comorbidities 6.