ER Docs Can Tell Difference Between Stroke and Bell's Palsy

Symptoms of Bell's palsy and stroke can be nearly identical, 

but emergency doctors were able to identify nearly all 

patients with Bell's palsy, a new study reveals.

People with Bell's palsy commonly experience partial or 

complete weakness of the muscles of half of the face, 

making them unable to raise one eyebrow, wrinkle their 

foreheads or close one eyelid. Symptoms of Bell's palsy 

progress fairly rapidly and strongly resemble the symptoms 

of certain types of stroke.

Bell's palsy affects about 15 of 100,000 people per year. It 

causes temporary facial paralysis, likely due to damage or 

trauma to facial nerves.

In this study, researchers analyzed the records of nearly 

44,000 patients who were diagnosed with Bell's palsy at 

emergency departments over six years. Ninety days after 

their ER visit, 0.8 percent of the patients received an 

alternate diagnosis, such as stroke, brain bleed, brain 

tumour, central nervous system infection, Guillain-Barre 

syndrome, Lyme disease, ear infection or shingles.

When narrowed down to alternative diagnoses that were life-

threatening, only 0.3 percent of the patients were 

misdiagnosed with Bell's palsy, according to the study 

published recently.

"Even lacking established guidelines for diagnosing Bell's 

palsy, which is the most common cause of paralysis of one 

side of the face, emergency physicians make the right call 

nearly every time," according to lead author.

"The dramatic and distressing nature of facial paralysis often 

brings patients to the ER for evaluation, often with a concern 

that they are having a stroke. The combination of thorough 

history-taking and detailed physical exam allows emergency 

physicians to determine which patients have a dangerous 

condition and which can safely be discharged home," Dr. 

said. "While there may be a role for imaging, such as CT or 

MRI, the overwhelming majority of patients can be evaluated 

without advanced diagnostic tests."

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