Bell’s Palsy vs Stroke: What’s The Difference?

When there’s a sudden facial deviation to one side, two major things come to mind: a stroke and Bell’s palsy.

Bell’s palsy and stroke tend to mimic each other because of some of the presenting signs of these conditions. However, they aren’t the same thing.

Knowing how to differentiate them is important because their associated symptoms, treatment, and preventive tips are quite different.


The Differences Between Bell’s Palsy And Stroke?

While Bell’s palsy is a neurological condition that causes paralysis of one side of the face due to compression or inflammation of the facial nerve, stroke, is a medical condition in which there is reduced flow to the brain killing some cells which can lead to paralysis of one side of the body with the face included.

If facial paralysis is related to stroke, it is usually known as Facial Palsy. Facial paralysis is a similar symptom in both bell’s palsy and stroke.

Bell’s Palsy


Inability to frown or wrinkle the foreheadMay frown and wrinkle forehead
Only the face is affectedUnilateral part of the body is also affected
It affects the entire side of the faceIt mostly affects the lower part of the face
Usually caused by a viral infectionIt is caused by reduced flow to the brain
Inability to close the eyesMay close eyes
Foods rich in B6, B9, and B12 can help support the nervous system and may help in preventing Bell’s palsy.It can be prevented by:
  • Living an active lifestyle
  • Maintaining a healthy diet and healthy weight
  • Being compliant with medications to control blood pressure and blood sugar
  • Check blood pressure and blood sugar regularly
  • Reduce alcohol and tobacco intake
  • Be regular with medical check-ups

What Causes Stroke?

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1. Being Obese

Fatty deposits can build up in the arteries which can cause narrowing of the arteries and reducing blood flow to the brain which can lead to stroke.

2. High Blood Pressure

This is the pressure of the blood in the arteries. Increased blood pressure may weaken the blood vessels because of the increased pressure which may later cause the arteries to burst to lead to internal bleeding in the brain.


3. Thrombosis

Living a sedentary lifestyle and other factors can lead to a blood clot. This blood clot is known as a thrombus. This thrombus can be dislodged to the brain, becomes an embolus, and blocks blood vessels thereby reducing blood flow to the brain and lead to a stroke.

Other causes include:

  • Diabetes
  • A family history of stroke

What Causes Bell’s Palsy?

If the facial nerve is affected along its course as it exits the skull, it leads to Bell’s palsy. There is actually no known cause for Bell’s palsy but some suspected causes of Bell’s palsy are:

1. Viral Infections

Any viral infection to either the ear or nose or any organ around the facial nerve can cause compression to the facial nerve.

2. Trauma

A direct hit to the face at the stylomastoid foramen or around the temple may cause a mild inflammation which may compress the nerve along its passage.


3. Environmental Factors

Traveling long distances with the wind blowing in the ear or being exposed to extreme cold weather have been shown to numb the facial nerve which can cause Bell’s palsy.

4. Tumors

Having a tumor in the skull may compress the facial nerve which may cause Bell’s palsy.

How Do I Know If I Have Bell’s Palsy?

  • One side of the face is weak
  • Difficulty keeping food in the mouth
  • Difficulty speaking
  • Difficulty frowning
  • Being unable to close the eye on the affected side
  • Drooling
  • Eye becomes watery

How Do I Know If I Have A Stroke?

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  • Weakness on one side of the body
  • Weakness on one side of the face
  • Loss of balance
  • Slurred speech or inability to speak
  • Irregular walking pattern
  • Drooling
  • Lack of coordination

How Is Bell’s Palsy Treated?

Bell’s palsy and facial paralysis in stroke have the same form of treatment except for the type of medications that are being used. Physiotherapy and other forms of treatment remain the same for both conditions.


Steroids, anti-inflammatory or antiviral medications are usually recommended for patients with Bell’s palsy.


Physiotherapy will help in strengthening the weak facial muscles through exercises and some home programs. A nerve or muscle stimulator is usually placed on the face to stimulate the facial nerve and the weak muscles.

Facial Exercises

Facial expressions are usually used as exercises. They are usually done in front of the mirror so that the affected person can try to correct the deviation of the face. Some of these exercises include:

  • Side smiling to the weaker side
  • Puffing of cheeks
  • Pronouncing labial sounds such as m, n, p, b
  • Blowing a balloon
  • Stretches to the unaffected side as the muscles may tighten over time


A special kind of elastic plaster called a “Kinesiotape” is used to pull the face towards the affected side to almost correct the mouth deviation and asymmetry of the face depending on the patient’s presentation.

Day to day modifications

People with facial paralysis are usually advised to:

  • Drink water with a straw to exercises the weak muscles of the face
  • Wear sunglasses to protect the opened eye from any form of infection and foreign objects
  • Sometimes, chewing gum on the affected side is usually advised although there have been various school of thoughts concerning it


A decompression surgery can be done on the facial nerve to relieve the pressure on the nerve. This is always the last option.

How Is Stroke Treated?


The first line of treatment is to control what caused the stroke in the first place. Anti-hypertensives are prescribed for hypertensive patients, medications are also prescribed for diabetic patients.


The goal of physiotherapy in stroke is to ensure that the patient can get a level of independence and return to how the person was before the stroke occurred.

Depending on the assessment done by the physiotherapist, the physiotherapist will draw up a treatment plan with the patient that is subject to change as the patient improves.

Some of these treatments include:

  • Strengthening exercises to the affected arm and leg
  • Trunk strengthening exercises
  • Balance and coordination exercises
  • Gait training by using a walking frame or parallel bars
  • Preventing deformities by stretching tight muscles if any
  • Using orthotics such as a splint to prevent joint deformities due to poor positioning.
Latest posts by Adekanmi Lipede, M.Sc, MPH (see all)
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