stroke AND bell's palsy???

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      Re: stroke AND bell's palsy???
    


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Posted by ccf neuro M.D. on May 26, 1997 at 10:23:02:

In Reply to: stroke AND bell's palsy??? posted by Anonymous

: I suffered a mild stroke three months ago. The main symptom has been extreme spasticity in the left side. I have been receiving physiotherapy for the muscle knots. Suddenly I developed facial paralysis on the right side, diagnosed as Bell's Palsy. My doctor said it was unreleated to my stroke. I find this hard to believe. How can a person suffer two serious neurological events in such a short time without one contributing in some way to the other?
  Any suggestions on treatment would be appreciated.
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Dear A., I share your concern about the close proxinity of these two events to each other, and would have to honestly say that your second event is another stroke until proven otherwise. It is possible for the same artery of the brain, known as the basilar artery, to be diseased and produce both of the types of deficits you have described. Whenever one suffers facial weakness that is both upper (eye, eyebrow) and lower (mouth), the natural presumption is that this is secondary to a Bell's palsy, a condition caused by reactivation of dormant herpes viruses that reinfect the facial nerve. Most strokes in the brain only result in weakness of the lower part of the face, since both sides of the brain control both sides of the upper face. However, there is a part of the brain known as the brainstem, where the nerve fibers that ultimately become the facial nerve are concentrated together, and if this part of the brain has a small stroke, both the upper and lower parts of the face can be paralyzed. As long as you have had some sort of imaging study like an MRA (magnetic resonance angiogram) and/or MRI to exclude disease of this basilar artery in the brain and/or damage to the brainstem itself, respectively, you can then diagnose a Bell's palsy, which is always a so-called diagnosis of exclusion (in other words, other possible causes of the same symptoms must be excluded before one can conclude that the real cause is the Bell's palsy). If your doctor is not a neurologist, I would suggest that you see a neurologist immediately, as you have had two events in very close proximity to each other, and since both could be the tip of a much more ominous iceberg such as your heart throwing blood clots to your brain or disease in this artery I mentioned (which, if closed off completely, is usually fatal). I would see the neurologist even if your family doctor refuses to send you to one and you must pay for the visit yourself in this particular circumstance. If you are near the Cleveland area and are interested in seeing one of our   stroke neurologists, I would recommend Dr. Tony Furlan or Dr. Cathy Sila. The department's appointment number is 216-444-5559 or 1-800-223-2273 ext. 4559. I hope you find this information useful.