Facial paralysis: is it a stroke?

Facial paralysis: is it a stroke?



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Facial paralysis: stroke or facial palsy?

Half-sided paralysis of the face makes most people think of a stroke involuntarily, but behind the complaints there can also be a so-called facial palsy. This facial paralysis is caused by a functional disorder of the facial nerve, which in turn can have various causes. However, a medical examination of the symptoms is always required.

The symptoms of facial palsy often appear relatively suddenly. The facial muscles appear partially or completely paralyzed, those affected cannot close their mouth properly, the corners of their mouth hang, the forehead cannot be frowned and the eyelid cannot be closed properly. Nose-bumping is also not possible, and those affected sometimes suffer from “abnormal sensations on the cheek or a feeling of pressure on the ear”, “Spiegel Online” quotes specialist Josef Heckmann from the German Society for Neurology (DGN). Disorders of the sense of taste and hypersensitivity to noise are also possible symptoms. However, since a layperson could not tell whether the symptoms were due to a stroke or facial palsy, an emergency doctor should be alerted immediately, according to the expert

In facial palsy, the facial paralysis is due to a functional disorder of the facial nerve that emerges from the brain stem, leaves the skull base in the area of ​​the temporal bone behind the earlobe, runs through the salivary gland and then spreads out in a fan-shaped manner over the face in fine ramifications, explained the specialist for neurology and senior physician at the University Clinic Hamburg-Eppendorf, Günther Thayssen, in the "Spiegel Online" article. Among other things, the nerve supplies the facial muscles, parts of the salivary glands and the tear glands. It is also necessary for the sense of taste in the front area of ​​the tongue. The symptoms of a malfunction of the seventh cranial nerve can be correspondingly extensive.

75 percent of facial palsy without a recognizable physical cause A distinction is made between so-called "peripheral facial palsy" (damage to parts of the facial nerve), "central facial palsy" (central nerve damage in the brain) and "idiopathic facial palsy" (no physical cause recognizable). According to the experts, the latter applies to around 75 percent of cases. Around 25 out of 100,000 people develop this most common cranial nerve disease every year. In the remaining 25 percent of facial paresis, possible reasons include infections with viruses (e.g. chickenpox virus, Epstein-Barr virus) or bacteria (e.g. Mycobacterium tuberculosis, Borrelia), autoimmune diseases of the nervous system (e.g. Guillain-Barré Syndrome), injuries (e.g. fractures) and tumors.

Herpes simplex virus as a trigger in the discussion To date, no clear physical cause can be identified for the idiopathic paralysis of the facial nerve, but according to the DGN expert Heckmann, experts are discussing whether a reactivated herpes simplex virus might be involved can trigger the paralysis. According to the theory, the inflammatory processes occurring in the context of such a reactivated infection could cause a swelling of the facial nerve in the narrow bony facial canal. This would pinch the nerve and disrupt its function. "We know that the nerve is swollen and the blood flow can be reduced as a result," emphasized Josef Heckmann.

Comprehensive examinations required As soon as the emergency doctor arrives, he will first check whether there is a stroke. If this is not the case, further specialist examinations follow, in which imaging procedures such as computer tomography or magnetic resonance imaging are used to look for injuries, tumors and bleeding in the brain. A blood test provides information on possible inflammatory processes and infections. A so-called "lumbar puncture", in which "brain-spinal fluid is removed and examined", may be necessary for the diagnosis, the DGN expert explained. If a physical cause of facial palsy can be determined, the subsequent therapy is based on this.

Therapeutic treatment of facial palsy is usually unavoidable. In general, treatment of facial palsy is usually necessary because the incomplete closure of the eyelid threatens to dry out the cornea of ​​the eye, which in turn can trigger inflammation of the eye. Therefore, according to Josef Heckmann, sufferers should "diligently care for the eye with a dexpanthenol eye ointment." A so-called watch glass bandage could also protect the eye overnight. Furthermore, according to the specialist, cortisone tablets should be taken for about ten days. Additional facial massages and facial expressions could also have a positive effect on the healing process. Affected people also report a promising effect of lymphatic drainage. According to the experts, the idiopathic facial paresis resolves after a maximum of eight weeks depending on the extent of the functional impairment in around 80 percent of the patients. However, the remaining patients often suffer considerably longer and may show permanent paralysis of the facial nerve. In the worst case scenario, an operation would have to be considered, especially to make it possible to close the lid again, Günther Thayssen explained. (fp)

Image: Uta Herbert / pixelio.de

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Video: Approaching Facial Paralysis