What are you supposed to think when you wake up and half of your face isn’t working? That was the question one of my patients recently had to ask herself. When she smiled in the mirror, only the left side of her mouth went up. When she tried to close her eyes, only the left eye closed. And when she tried to lift her eyebrows, only the left eyebrow worked, and only the left forehead wrinkled. She brushed her teeth and tried to swish out her mouth and the water went spilling out of the weak side of her mouth. Stroke? Fortunately not, although when in doubt it’s always best to get immediately to the ER.
One clue that this was Bell’s palsy and not stroke was the lack of movement of the right forehead. When a stroke is the cause, the forehead is usually spared and still moves (wrinkles) on both sides – we won’t get into the whole reason for that – but with Bell’s palsy it doesn’t.
So what is this stroke-mimicker that affects only the face? Bell’s palsy is an acute affliction of the facial nerve. It results in rapid paralysis or weakness of the facial muscles on one side of the face, usually progressing over up to 48 hours. The cause still isn’t definitively known. It can happen at any age, but its peak prevalence is in 40-49 year olds.
Along with the one-sided facial paralysis, there may be altered taste and loss of tear production on the affected side. There also may be pain around the ear and sometimes vision is blurred on the affected side.
Treatment involves first making sure it’s Bell’s palsy and not a stroke. If the symptoms aren’t clear-cut, a cat scan or MRI of the head is sometimes done to rule out tumor or stroke. Steroids are the preferred treatment and antiviral agents may sometimes improve outcomes slightly as well.
The good news is that in 80-90% of cases, the symptoms slowly clear over a few months’ time. In the meantime, the affected eye needs to be protected with frequent lubrication, and sometimes taped shut overnight to avoid drying out and damaging the cornea. Facial physical therapy is sometimes used but hasn’t really proved to make a notable difference in the rate of recovery. Various surgical procedures are used only rarely to aid eye closure in those cases where the paralysis proves permanent.
So, while Bell’s palsy certainly beats a stroke, it’s no picnic and can be very slow to resolve, or rarely, may not resolve fully. And as we said at the beginning, always best to get to the ER immediately with any sudden paralysis or loss of function.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835