Patty relates her story: “So I’m out for a nice dinner with my husband and it’s so embarrassing — as I’m drinking my water, it keeps dribbling out of the corner of my mouth. At first I think I’m just being spastic and hope he didn’t notice. But it keeps happening and I laugh and tell him my mouth doesn’t seem to be working right. So he looks at me, and instead of laughing he suddenly looks scared and says, ‘C’mon we’ve got to get you to the hospital.’ What I didn’t know is that when I laughed, one side of my face moved normally and the other barely moved at all. Of course he’s thinking, stroke!”
This account turned out, happily, to not be a stroke, but rather a condition called Bell’s palsy. Of course, when in doubt it’s always best to get immediately to the ER and make sure it isn’t a stroke. Bell’s palsy involves a loss of function of the facial nerve. This is the nerve that triggers most of the movements of the muscles of the face. So Bell’s palsy 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 hasn’t been totally nailed down. It can happen at any age, but its peak prevalence is in 40-49 year olds.
When Bell’s palsy first strikes, it can be tough to distinguish from a stroke. One clue is that with Bell’s palsy the forehead muscles on the paralyzed side don’t move. So if you ask the person to raise their eyebrows or wrinkle their forehead, nothing happens on the paralyzed side. On the other hand, when a stroke is the cause, the forehead muscles are usually spared and still move (wrinkle) on both sides – we won’t get into the whole reason for that, but it’s one way to help distinguish the two.
Along with the one-sided facial paralysis, Bell’s palsy may cause 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 may be done immediately since successful stroke treatment is often dependent on the timely use of clot-busting meds. If Bell’s palsy is diagnosed, 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 much of a 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, having Bell’s palsy certainly beats having a stroke, but it’s still no picnic. It can sometimes be very slow to resolve, or rarely, may not ever fully recover. If it strikes you or someone you love, and you’re not sure what it is, get to an ER and let them make sure it’s not a stroke. Once you’re sure it’s Bell’s palsy they can help you to protect your eyes and give you meds that maximize your chances for a full recovery.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835.