Stroke or Bell’s Palsy?

The following paramedic case study identifies the difficulty in determining the difference between a Stroke and Bell’s Palsy in the prehospital care setting.

You care called to a 35 year old female, currently 21 weeks pregnant who has developed a sudden episode of slurred speach and dizziness. On arrival, you find an overweight 35 year old female in minor distress and mild confusion who states she doesn’t know what’s happening to her. On examination, you find that her skin is warm, pink dry. Her GCS is 15, although she has markedly slurred speech and is difficult to understand. She has a right sided facial droop, but good motor and sensory responses to all four limbs. She is afebrile and has a normal blood glucose level. She is monitored in a sinus tachycardia at 112 beats per minute.

Your treatment includes reassurance, oxygen therapy, and more reassurance. Your inclination is that she has Bell’s Palsy and not a stroke, but then again, how do you know?

Stroke and Bell’s Palsy Lessons Learned

1. Pregnant women are at a greater risk of a variety of medical disorders that may be causing these effects, include pre-eclampsia/eclampsia and gestational diabetes.

2. You can differentiate between a stroke and bell’s palsy by asking the patient to raise both eyebrows. If she is capable of raising both, then it is more likely to be bell’s palsy and not a stroke, if she can only raise her eyebrows on one side, then she is likely to have had a stroke.

3. Regardless of whether or not this person is having a stroke or experiencing the side effects of bell’s palsy, the patient is going to be pretty scared, so constant reassurance is vital!

4. Stroke therapy normal requires interventions within 4 hours of the onset of stroke like symptoms. Therefore, these patients should be expedited to the nearest hospital equipped to treat a potential stroke.

Learn how to differentiate Bell’s Palsy from Stroke here.