Have a patient with facial droop without any additional symptoms? Do you suspect Bell’s palsy?

One way to differentiate between Bell’s palsy or a stroke is if the forehead is affected or not.

Bell’s palsy always affects the forehead/eyebrow. The patient will not be able to move these muscles. With a stroke though, the forehead/eyebrow is typically spared.

Have the patient wrinkle their forehead as if they are surprised about something. With a stroke, the forehead should lift symmetrically. However, with Bell’s palsy, the patient will be unable to wrinkle their forehead on one side or have fewer wrinkles on that side. Asymmetry is a sign of Bell’s palsy.

Additionally, Bell’s palsy typically occurs over a few hours to days whereas a stroke occurs within minutes. Patients with a stroke should also have additional symptoms including weakness, numbness, speech difficulty, gait disturbances etc. Bell’s palsy typically has no other associated symptoms.

So, before you send the patient to the ER unnecessarily, check those forehead muscles! It would always amaze me the patients arriving by ambulance to the ER for simple Bell’s palsy… We did not even bother doing a CT because it was so obvious based off the exam. It was a total waste of money, time, and resources… As always, use your own clinical judgment.