Stroke vs Bell’s Palsy: How to Tell the Difference & What to Do

Introduction
Facial droop or sudden muscle weakness on one side of the face can be alarming. Many people fear a stroke, but sometimes the cause is Bell’s palsy, a condition affecting the facial nerve. Because the two conditions can look similar, knowing the differences is vital. In this article, we compare stroke vs Bell’s palsy, explain symptoms, diagnosis, treatment, and when to seek emergency care.

Stroke vs Bell’s Palsy: How to Tell the Difference and What to Do

What Is a Stroke?

A stroke occurs when blood flow to part of the brain is interrupted, either by a clot (ischemic stroke) or by bleeding (hemorrhagic stroke). Brain cells in the affected area begin to die within minutes, causing sudden neurologic deficits.

Common stroke symptoms include:

• Sudden weakness or numbness in the face, arm, or leg (especially on one side)

• Confusion, trouble speaking or understanding speech

• Vision problems in one or both eyes

• Trouble walking, dizziness, loss of balance or coordination

• Severe headache with no known cause

One widely used tool is FAST: Face, Arm, Speech, Time from the American Stroke Association.

• F = Face droop

• A = Arm weakness

• S = Speech difficulty

• T = Time to call 911

Early treatment is critical because the sooner blood flow is restored, the better the outcome.

What Is Bell’s Palsy?

Bell’s palsy causes sudden weakness or paralysis on one side of the face due to inflammation or compression of the facial nerve (cranial nerve VII). While frightening, it usually does not involve the brain or other body parts.

Key points about Bell’s palsy:

• Onset is often rapid over hours or a day

• Drooping affects the entire half of the face, including the forehead

• Other possible features: pain behind the ear, changes in taste, sensitivity to sound, dryness or tearing in the eye

• Many patients recover fully over weeks to months (often within 3 to 6 months)

• Treatment often involves corticosteroids (if started early), eye protection, and supportive care

Because Bell’s palsy is a nerve-level condition, it typically spares other motor or sensory functions outside the face.

Stroke vs Bell’s Palsy Symptoms

Because of overlap, isolated facial droop is sometimes misdiagnosed. Some strokes mimic Bell’s palsy, especially pontine strokes. Misdiagnosis can delay lifesaving stroke care.

When to Seek Emergency Care

Any sudden facial weakness should prompt urgent evaluation. Assume stroke until proven otherwise because time is critical. Call 911 if someone shows signs of FAST. Even if Bell’s palsy is suspected, prompt medical assessment helps confirm diagnosis and start treatment. Delays reduce the benefit of steroids for Bell’s palsy.

How Are They Diagnosed?

• Clinical exam: A physician will test facial muscle strength, sensory or reflex changes, eye closure, and forehead movement. Bell’s palsy is often a diagnosis of exclusion.

• Imaging tests: CT or MRI scans detect strokes or rule out other brain lesions.

• Electromyography (EMG): Sometimes used in Bell’s palsy to assess nerve damage.

• Blood tests: May rule out infections, diabetes, or other contributing factors.

Treatment and Recovery of Stroke & Bells Palsy

Bell’s Palsy

• Corticosteroids (high dose for about 7 to 10 days) improve recovery if started early

• Antivirals are sometimes used, though evidence is limited

• Eye protection with lubricating drops or a patch is important if eyelid closure is impaired

• Facial exercises or physical therapy may help

• Prognosis: Most improve gradually, many fully recover within 3 to 6 months

Stroke

• Ischemic stroke: Thrombolytics, mechanical thrombectomy, antiplatelet therapy

• Hemorrhagic stroke: Bleeding control and sometimes surgery

• Rehabilitation such as physical therapy and speech therapy

• Risk factor management for long-term prevention

Recovery depends on how quickly treatment begins and how much brain tissue was affected.

Why It Matters: The Risks of Misdiagnosis

Mistaking a stroke for Bell’s palsy can delay critical therapy. Overcalling Bell’s palsy when it is actually a stroke can lead to worse outcomes. Some strokes, especially brainstem or pontine strokes, present with isolated facial paralysis and are difficult to distinguish.

Conclusion

If you or someone you know experiences sudden facial drooping, do not wait. Call 911 right away. Even if it turns out to be Bell’s palsy, it is better to rule out stroke quickly. Early evaluation gives the best chance for recovery.

At iCare ER & Urgent Care, we provide rapid evaluation, imaging, neurological consultation, and treatment for suspected stroke and Bell’s palsy. Seek care immediately when symptoms appear, and visit one of our locations in Frisco, Fort Worth, or Forney.