How Can You Tell the Difference Between Bell's Palsy and a Stroke?

Bell's palsy and stroke are medical conditions that start in the brain. Bell's palsy causes temporary paralysis of facial muscles while stroke is caused by a blood clot or ruptured blood vessel in the brain.

Bell's palsy and strokes are two medical conditions that start in the brain. To the average person, the signs of Bell's palsy look a lot like a stroke's symptoms, but they are vastly different. Bell's palsy is caused by damage to a single nerve, whereas a stroke is caused by a lack of oxygen and blood to the brain. 

Although they both begin in the brain, they affect different parts of the body and brain. While Bell's palsy is alarming, a stroke is a medical emergency that needs professional attention right away. It's important to understand the difference between Bell's palsy and a stroke so you can respond to each situation in the best way possible. 

What is bell's palsy?

Bell's palsy is a type of temporary muscle weakness or paralysis (palsy) in the face.  This makes parts of the face droop. It affects one side of the face most commonly, but on rare occasions, it can affect the entire face. When you have Bell's palsy, you may have trouble closing one eye, have trouble smiling, or notice a drooping eyelid. 

Bell's palsy can happen to anyone, but it most commonly affects people between the ages of 15 and 60. It affects both men and women equally. 

What is a stroke?

A stroke happens when a blood vessel leading up to or inside the brain is blocked by either a clot or a rupture. This is a medical emergency because it causes a part of the brain to stop receiving oxygen and nutrients from the blood. It's estimated that 800,000 people in the U.S. experience a stroke each year. 

Different types of strokes have different causes:

• Ischemic Strokes are caused by clots that prevent blood from reaching the brain. These account for 87% of all strokes.
• Hemorrhagic Stroke happens when a weakened blood vessel ruptures. Two types of weakened blood vessels lead to these kinds of strokes, aneurysms and arteriovenous malformations (AVMs).
• Transient Ischemic Attack (TIA) is considered a mini-stroke and is caused by a temporary clot. This kind of stroke is a major warning sign that a more serious attack is possible. 
• Cryptogenic Stroke is a block in a blood vessel leading up to the brain. Strokes that have an unknown cause are also considered Cryptogenic. 
• Brain Stem Stroke is a stroke that happens in the brain stem. This affects both sides of the body and can leave a person in a "locked state", which causes an inability to speak or move below the neck.  

This is where a lot of confusion comes in because, at first glance, Bell's palsy appears to have the same symptoms as a stroke. The facial paralysis it causes is a similar symptom to those of a stroke. 

Symptoms of Bell's palsy

The symptoms of Bell's palsy come on suddenly and worsen over the first 48 hours. These are the most common symptoms: 

• Loss of feeling in your face
• Jumbled movements of the muscles that control the face. For instance, you might have trouble blinking or smiling.
• Headache
• Drooling
• Tearing
• Extreme sensitivity to sound in the affected ear (hyperacusis)
• No sense of taste on the first two-thirds of the tongue
• Trouble or inability to close the eye on the affected side of your face.  

Symptoms of a stroke

Each second counts when it comes to recognizing and responding to a stroke. Acting quickly will lessen the amount of brain damage caused by the lack of oxygen and can even save a life. 

These are the most common symptoms of a stroke:

• Sudden weakness or numbness in your face, arms, or legs, especially if it's on one side of the body.
• Difficulty speaking, comprehending, and understanding speech.
• Trouble seeing out of one or both eyes suddenly.
• Sudden dizziness and trouble with coordination that affect walking and balance. 
• Sudden and unexpected severe headache

Not only do Bell's palsy and strokes have different symptoms, what causes them is different too. Knowing what the causes of each are will help you understand the level of severity of each condition. 

Causes of Bell's palsy

Bell's palsy happens when there is damage to the 7th cranial nerve in the brain, which controls the facial muscles. What exactly causes this damage is unknown, but it is frequently connected to a viral infection .

Some common viral infections that have been connected to Bell's palsy include:

• Chickenpox and shingles (herpes zoster)
• Cold sores and genital herpes (herpes simplex)
• Mumps (mumps virus)
• Infectious mononucleosis (Epstein-Barr)
• Respiratory illnesses (adenovirus)
• Flu (influenza B)
• Cytomegalovirus infections
• German measles (rubella)
• Respiratory illnesses (adenovirus)

Causes of a stroke

Strokes are caused by a blocked or ruptured blood vessel inside or leading up to the brain. Multiple conditions can trigger this or make you more susceptible to having a stroke:  

• High blood pressure
• High cholesterol 
• Heart disease
• Diabetes
• Sickle Cell Disease
• Previous stroke or transient ischemic attack

Diagnosing Bell's palsy does not require any specific testing. Instead, your doctor will analyze your face by asking you to move different muscles. This includes raising your eyebrows, closing your eyes, frowning, and smiling, among other things. Since there are other potential causes of facial paralysis, like a stroke, they may conduct additional testing if it's still not clear. The most common tests used are Electromyography (EMG) and CT or MRI imaging scans. 

For strokes, your diagnosis is based on several factors. Doctors use multiple tests and imaging scans to assess the condition of the brain and its blood supply. This allows them to outline where the brain was injured.  

Tests that are conducted include:

• Physical and neurological exams
• Medical history to see if you have a history of stroke or conditions that trigger it. 
• Lab tests (blood tests) to look at blood cell count, cholesterol levels, and more. 
• CT or MRI scans to obtain the location and severity of the brain injury. 
• Blood flow test to determine the amount of blood flow through the affected vessel. 
• Additional diagnostic tests like an Electroencephalogram (EEG) or an Evoked Response Test.

Treating Bell's palsy is vastly different from treating a stroke, and most people with it will experience a full recovery. It typically starts to clear up on its own after two weeks and is completely gone after a few months. 

No one treatment regimen is recommended, and your doctor may recommend a combination of medication and physical therapy. However, doctors usually always prescribe eye-protection to prevent the drooping eye from drying out overnight. 

Some common treatments for Bell's palsy include:

• Steroids like prednisone to reduce inflammation.
• Antiviral medication like acyclovir if the root cause is known.
• Analgesics for pain relief
• Physical therapy to stimulate facial nerves and muscles

Treating a stroke is much more complex, and the treatment depends on what type of stroke you've had. For an Ischemic stroke, the focus is on getting blood flow back to the brain. For a Hemorrhagic stroke, the goal is to control bleeding, reduce pressure on the brain, and stabilize vital signs.