Is it Bell's palsy or a stroke? Emergency physicians have the answer

July 26, 2013

Emergency physicians correctly identified nearly 100 percent of patients with Bell's palsy, the symptoms of which are nearly identical to potentially life-threatening diseases such as stroke and brain tumors. The results of a study of 6 years of California patient records were published online yesterday in Annals of Emergency Medicine.

"Even lacking established guidelines for diagnosing Bell's palsy, which is the most common cause of paralysis of one side of the face, emergency physicians make the right call nearly every time," said lead study author Jahan Fahimi, MD, MPH, of Alameda County Medical Center in Oakland, Calif. and the University of California, San Francisco. "The dramatic and distressing nature of facial paralysis often brings patients to the ER for evaluation, often with a concern that they are having a stroke. The combination of thorough history-taking and detailed physical exam allows emergency physicians to determine which patients have a dangerous condition and which can safely be discharged home. While there may be a role for imaging, such as CT or MRI, the overwhelming majority of patients can be evaluated without advanced diagnostic tests."

Researchers analyzed 43,979 records for patients discharged from California emergency departments with a diagnosis of Bell's palsy. At 90-day follow up, 0.8 percent of those patients received an alternate diagnosis, such as stroke, brain bleed, brain tumor, infection, Guillain-Barre syndrome, Lyme disease, ear infection or herpes zoster. When restricted to only life-threatening alternative diagnoses associated with central , only 0.3 percent were misdiagnosed.

Patients with Bell's palsy commonly manifest partial or complete weakness of the muscles of half of the face, resulting in an inability to raise one eyebrow, wrinkle their foreheads or close one eyelid. Symptoms often progress fairly rapidly and strongly mimic the symptoms of certain types of stroke. It affects approximately 15 people out of 100,000 every year.

Explore further: Bell's Palsy treatment not being consistently applied, says study

More information: Annals of Emergency Medicine DOI: 10.1016/j.annemergmed.2013.06.022

Related Stories

Bell's Palsy treatment not being consistently applied, says study

July 19, 2013
Clinical treatment of the disfiguring condition Bell's Palsy - which affects around 1 in 60 people in their lifetime - is not consistently following the latest recommendations from research trials, a study led by the University ...

Guideline: Steroid pills effective for treating facial paralysis in Bell's palsy

November 7, 2012
For people experiencing first-time symptoms of Bell's palsy, steroid pills very likely are the most effective known treatment for recovering full strength in the facial muscles, according to a guideline published in the November ...

Research examines effect of prednisolone in patients with Bell palsy

May 21, 2012
Treatment for Bell palsy (a condition involving the facial nerve and characterized by facial paralysis) with the corticosteroid prednisolone within 72 hours appeared to significantly reduce the number of patients with mild ...

Emergency physicians use new tool to detect drug-seekers in the ER

July 10, 2013
Emergency physicians and other emergency department staff were fairly accurate in assessing which patients were drug-seekers in the emergency department, changing their prescribing plans for less than 10 percent of patients ...

Cost of treating dizziness in the emergency room soars

July 17, 2013
A new Johns Hopkins research report says emergency room visits for severe dizziness have grown exponentially in recent years, with costs topping $3.9 billion in 2011 and projected to reach $4.4 billion by 2015. The investigators ...

Intense acupuncture can improve muscle recovery in patients with Bell palsy

February 25, 2013
Patients with Bell palsy who received acupuncture that achieves de qi, a type of intense stimulation, had improved facial muscle recovery, reduced disability and better quality of life, according to a randomized controlled ...

Recommended for you

Two studies support intensive blood pressure control for long-term health, quality of life

August 23, 2017
Two studies provide additional support for lowering systolic blood pressure to an intensive goal of 120 mmHg - far below the standard guidelines of 140 mmHg - to reduce the risk of heart disease in high-risk patients with ...

Brain activity may be predictor of stress-related cardiovascular risk

August 23, 2017
The brain may have a distinctive activity pattern during stressful events that predicts bodily reactions, such as rises in blood pressure that increase risk for cardiovascular disease, according to new proof-of-concept research ...

Dramatic new studies into inflammation in the infarcted heart could lead to changes in therapy

August 23, 2017
A medical research collaborative has demonstrated that the response of the human heart to an infarction is very different than previously thought. The study, led by cardiologist Borja Ibáñez and published as two independent ...

'Shapeshifter' that regulates blood clotting is visually captured for the first time

August 23, 2017
We are normally born with a highly sophisticated array of molecules that act as "sentries," constantly scanning our bodies for injuries such as cuts and bruises. One such molecular sentry, known as von Willebrand factor (VWF), ...

New molecule may hold the key to triggering the regeneration and repair of damaged heart cells

August 21, 2017
New research has discovered a potential means to trigger damaged heart cells to self-heal. The discovery could lead to groundbreaking forms of treatment for heart diseases. For the first time, researchers have identified ...

Researchers investigate the potential of spider silk protein for engineering artificial heart

August 18, 2017
Ever more people are suffering from cardiac insufficiency, despite significant advances in preventing and minimising damage to the heart. The main cause of reduced cardiac functionality lies in the irreversible loss of cardiac ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.