Bell's Palsy vs. Stroke: What’s the Difference?

You may have heard that facial numbness and weakness are signs of a stroke. It’s true that changes in your face — like drooping and asymmetry — are early signs of a stroke. But they can also be signs of a condition called Bell’s palsy. While strokes and Bell’s palsy have some features in common, the two conditions are very different. Here’s what to know about stroke versus Bell’s palsy. 

What is a stroke?

A stroke is a type of brain injury that develops when your brain doesn’t get enough blood and oxygen.

There are two types of strokes: 

1. Ischemic stroke: An ischemic stroke happens when a blood vessel that leads to the brain gets blocked. Blood and oxygen can’t reach the brain when a blood vessel gets blocked.
   

   

2. Hemorrhagic stroke: A hemorrhagic stroke happens when there’s bleeding inside the brain. This can happen if a blood vessel in the brain breaks. 

A stroke is a medical emergency. It’s life threatening and can also cause life-long disability. 

Some strokes can be treated if they’re caught early. Treatment can help limit brain injury. That’s why it’s so important to know the early signs of a stroke. People who get help right away are more likely to survive a stroke and have better long-term health outcomes. 

What is Bell’s palsy?

Bell’s palsy is a condition that develops because of inflammation in the facial nerve (cranial nerve VII). People have two facial nerves: a right facial nerve and a left facial nerve. These nerves are responsible for controlling the muscles on either side of the face. This includes the muscles you use to:

• Smile

• Open and close your mouth

• Raise and lower your eyebrows

• Close your eyelids

The facial nerves also help control taste buds, salivary and tear glands, and muscles in the middle ear that help transmit sound. That’s why other symptoms of Bell’s palsy include:

• Changes in taste

• Increased sensitivity to noise

• Excessive tear production

• Drooling from excessive saliva production

People typically only develop Bell’s palsy on one side of their face. That means the other side of their face is able to move normally. 

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• Recovering from Bell’s palsy? Try these 7 exercises to help your facial muscles.

• Ramsay Hunt syndrome can also cause facial paralysis. Here’s our guide to the best treatments that can help you recover.

Is Bell’s palsy an emergency?

Bell’s palsy isn’t a medical emergency and symptoms usually go away within a few weeks. Most people recover completely. So, after recovery, it’s as if you never had Bell’s palsy at all. 

But symptoms can be very frightening at first. And it can be very hard to tell if what you’re experiencing is the start of Bell’s palsy or a stroke. 

How can you tell the difference between Bell's palsy and a stroke?

Both Bell’s palsy and stroke can cause facial weakness. This can make it look like one side of the face is drooping — either at the corner of the mouth or around the eyebrow. 

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Experts recommend seeking care right away if you develop facial numbness, drooping, or paralysis. 

You should call 911 if you have trouble moving the muscles in your face. You shouldn’t try to figure out if you have a stroke or Bell’s palsy on your own. 

If a loved one develops facial paralysis, call 911, right away. 

While you wait for help to arrive, you can look for other signs of a stroke. Here are some signs you might see with a stroke versus Bell’s palsy.

These differences can be very hard to tease out, especially under the stress of a potential medical emergency. That’s why it’s safer to get help as soon as possible. And, when it comes to a stroke, every minute counts. 

Even medical professionals won’t spend too much time trying to tell the difference between symptoms of stroke versus Bell’s palsy. They’ll perform tests and imaging studies that can show for certain whether or not someone is having a stroke. 

What are the emergency signs of stroke?

A stroke can happen all of a sudden to anyone, at any time. Experts developed the “BE FAST” acronym to help people remember the first signs of a stroke. 

“BE FAST” stands for:

• Balance loss: Ask the person to stand or walk. Are they having trouble staying upright?

• Eyesight changes: Ask the person if they can see. Are they seeing double or experiencing other vision changes?

• Facial drooping: Ask the person to smile. Is their smile even, or does one side of their face droop? Does the person have facial numbness?

• Arm weakness: Ask the person to raise their arms. Is one arm weak or numb? Does it drift downwards?

• Speech changes: Ask the person to speak. Is their speech slurred or difficult to understand? Are they unable to speak? 

• Time to call 911: Call 911 if you answer yes to any of these questions, even if the person’s symptoms are getting better or going away.

If you or someone around you is having symptoms of a stroke, act fast and call 911 immediately. First responders can start treatment for a stroke on the way to the emergency room. Brain injury gets worse every minute a stroke is left untreated. Acting fast can save a life.

Why trust our experts?

Written by:

Tracy Norfleet, MD, FACP

Dr. Tracy Norfleet is a board-certified Internal Medicine physician, health expert, and physician leader with over 20 years of experience practicing adult medicine. Dual-certified by the American Board of Obesity Medicine and the American Board of Lifestyle Medicine, Dr. Tracy possesses a wealth of knowledge and expertise in both traditional medical practices and innovative lifestyle interventions for chronic disease management and reversal.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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