Bell’s Palsy vs. Stroke: Spot the Difference

Joel Embiid poured in 50 points for the Philadelphia 76ers in a Game 3 win over the New York Knicks in the opening round of the NBA Playoffs.

But the 2023 MVP’S outstanding performance wasn’t the main conversation during the postgame press conference. His left eye hadn’t been blinking, and his face had been drooping. Embiid told reporters he had been diagnosed with Bell’s palsy the week prior.

What is Bell’s palsy?

“Bell’s palsy refers to the clinical signs of weakness of the facial muscles, involving one side. Both above the eye and below the eye,” says Deepak Nair, MD, the director of ambulatory and virtual neurology services at OSF HealthCare. “As opposed to what we commonly see in stroke patients, where there can be facial weakness, but it normally only affects the lower part of the face on one side.”

The National Institutes of Health (NIH) says the neurological disorder is the most common cause of facial paralysis.

Dr. Nair says the signs of Bell’s palsy and stroke can sometimes look identical. He says this requires extra attention to the anatomy of the nerve involved, which is the seventh cranial nerve, which controls the muscles of facial expression.

“A lot of that can be done by just talking to patients and having them move their facial muscles around,” Dr. Nair says.”

What causes Bell’s palsy?

In most cases, the direct cause of Bell’s palsy remains undetermined. But Dr. Nair says one of the most classic reasons is an acute viral infection.

“Especially with things like skin herpes lesions,” Dr. Nair says. “The herpes virus is a huge family. But also, when we as medical personnel say herpes, we also think about shingles, or the varicella virus, but it’s part of the herpes family. The one classic presentation of this is when there are shingles lesions inside the ear. Because there are branches of the facial nerve that travel in and by the ear.”

Dr. Nair adds that during the COVID-19 pandemic, both the COVID-19 virus and its vaccine had a connection to some Bell’s palsy patients. He says this is because when our immune system is primed to “behave inappropriately,” Bell’s palsy can occur.

How to manage symptoms

“Some people with Bell’s palsy can also have alterations in their hearing, which is often a heightened sensitivity. It’s like everything sounds louder on the affected side. And sometimes you can lose the sensation of taste on that side of the tongue,” Dr. Nair says.

He adds the most serious symptom to treat is if the muscles around the eye are not able to fully close.

“Especially when we’re asleep. You can start to worry about injury to the corneal surface of the eye, which can lead to vision loss. A lot of what we do is offering a lubricating solution for the eye, sometimes even a device to keep the eye closed,” Dr. Nair says.

Dr. Nair says if you’re concerned you may have Bell’s palsy, speak with your primary care provider first, who then can refer you to a specialist if needed.