Facial Deviation in Stroke Patients
Facial deviation is present in approximately 46-67% of acute stroke patients, making it one of the most common and recognizable neurological deficits in stroke presentation. 1, 2, 3
Prevalence and Clinical Significance
Facial weakness or deviation is a key component of stroke assessment tools used by healthcare providers to identify potential stroke patients. The Cincinnati Prehospital Stroke Scale (CPSS), one of the most widely used stroke screening tools, specifically evaluates facial droop as one of its three core assessment criteria 4.
When examining facial deviation patterns:
- Lower facial muscles are more significantly affected than upper facial muscles in hemispheric strokes 1
- Facial asymmetry is commonly observed but may be discrete in some patients 2
- Facial deviation typically occurs toward the ipsilesional side (same side as the brain lesion) 5
Relationship with Stroke Severity and Outcomes
The presence of facial deviation has important prognostic implications:
- Patients with facial deviation often have higher baseline NIHSS (National Institutes of Health Stroke Scale) scores, indicating greater stroke severity 6
- Facial deviation is associated with lower ASPECTS (Alberta Stroke Program Early CT Score) on baseline CT scans, suggesting larger infarct volumes 6
- In unadjusted analyses, facial deviation correlates with decreased 3-month functional independence and increased mortality 6
Facial Deviation in Spatial Neglect
Interestingly, research has shown a strong correlation between facial deviation and spatial neglect:
- Patients with spatial neglect and right hemisphere lesions consistently show marked deviation of eyes and head toward the ipsilesional side 5
- The average spontaneous gaze position in patients with spatial neglect and right hemisphere lesions was found to be approximately 46 degrees to the right 5
- In contrast, stroke patients without spatial neglect tend to maintain gaze positions closer to the midline 5
Assessment and Rehabilitation
Assessment of facial deviation should be part of the standard neurological examination for stroke patients:
- The Cincinnati Prehospital Stroke Scale evaluates facial droop by having the patient show teeth or smile, with abnormal findings defined as one side of the face not moving as well as the other 4
- Quantitative assessment can be performed using 3D video systems to measure distances between facial landmarks 1
- Orofacial therapy has shown significant benefits in improving facial movement after 4 weeks of treatment 3
Clinical Implications
Facial deviation serves as a valuable diagnostic indicator:
- The presence of facial deviation increases the probability of stroke by 72% when used as part of the CPSS 4
- Facial deviation assessment helps emergency medical services identify potential stroke patients with reasonable sensitivity and specificity 4
- Early recognition of facial deviation can facilitate prompt triage and treatment of stroke patients, potentially improving outcomes
It's important to note that while facial deviation is common in stroke, its presence alone is not sufficient for diagnosis, and comprehensive stroke assessment should include evaluation of other neurological deficits.