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Differentiating Facial Weakness Caused by Bell's Palsy vs. Acute Stroke - JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News

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You’re responding to a 54-year-old woman with facial weakness. The patient states she looked in the mirror this morning and noticed her face appeared “twisted.” She didn’t notice any facial asymmetry before going to bed the night before. She complains of no pain or numbness. Your assessment shows the right side of her mouth isn’t able to smile and she has difficulty closing her right eye. You perform a neurologic exam; strength and sensation are normal throughout, with no weakness in the arms or legs and no other neurologic findings. She’s able to communicate and answers all questions appropriately. Is this a stroke? Facial Weakness The two most common causes of acute facial paralysis are Bell’s palsy and ischemic stroke.1 EMS providers are often faced with the challenge of differentiating between these two diagnoses. Because acute stroke is a time-critical illness, the distinction between stroke and Bell’s palsy must be made quickly to avoid unnecessary delays in treatment. Anatomy of

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