Knowing the difference between stroke and Bell’s palsy

Last Modified: 5/20/2021

stroke or bell's palsy

This post was written by Katie Edwards, MSN, RN, CCRN-K, educator for professional development and clinical care, Parkview Health.

There are two types of conditions that can cause one-sided facial paralysis: stroke and Bell’s palsy. Symptoms seen in both conditions include facial drooping and the inability to close the eye of the affected side. [1] However, the treatment for stroke versus Bell’s palsy is very different.  

When someone begins experiencing stroke-like symptoms, time is of the utmost importance. For this reason, knowing the acronym for stroke symptom identification is vital. BE FAST is a simple tool to help remember stroke symptoms. The letters stand for the following:

  • Balance: Watch for a sudden loss of balance 
  • Eyes: Check for vision loss
  • Face: Look for an uneven smile or drooping on one side of the face
  • Arm: Check for weakness on one side of the body
  • Speech: Listen for slurred speech or the inability to speak normally
  • Time: Call 911 right away and at the onset of symptoms

Remember, no matter what the end diagnosis is for facial drooping or weakness, ruling out the possibility of a stroke first is critical for treating the person appropriately.


While stroke and Bell’s palsy symptoms can sometimes resemble each other with signs like drooling, trouble speaking, headache and difficulty eating, they couldn’t be more different. Let’s take a closer look at the warning signs for each condition.

Symptoms associated with Bell’s palsy can include:

  • Ringing in the ears
  • Sensitivity to sound
  • Changes in ability to taste
  • Watering from the affected eye [1,2]

Symptoms of a stroke may include:

  • Weakness in extremities on one side of the body
  • Numbness on one side of the face or body
  • Difficulty walking
  • Changes in vision for one or both eyes
  • Eyes may gaze in one direction
  • Trouble finding words

Anyone experiencing any of these symptoms should seek urgent medical attention right away. Your provider may order a CT scan or MRI and run blood tests such as glucose testing and white blood cell count to rule out diabetes symptoms or infection. [1,3] With that said, your provider may also require additional testing and evaluation to completely rule out a stroke or Bell’s palsy.


Bell’s palsy

For someone experiencing Bell’s palsy, obtaining a detailed health history of current conditions like hypertension, Lyme disease, skull fracture, middle ear infections, facial injury or an illness called sarcoidosis are important during diagnosis. Further testing may include an electromyography to test the facial nerves. Bell’s palsy treatment often involves the use of steroid and antiviral medication in some instances. Bell’s palsy symptoms usually resolve on their own over a few weeks to a few months. [1]


There are a variety of treatments for patients experiencing a stroke. Depending on the patient’s initial presentation and their CT or MRI results, treatment can vary. Additionally, a thorough health history concerning hypertension, heart disease, diabetes, smoking, alcohol use, recent falls, and other related health conditions is essential. Blood testing may also be needed to assess the following:

  • Glucose
  • White blood cells
  • Electrolyte imbalances
  • Coagulation (your blood’s ability to clot)
  • Hemoglobin A1C
  • Triglycerides
  • Cholesterol levels

Once your provider has all the necessary information, they will develop a treatment plan with the patient, family and interdisciplinary healthcare team. Some strokes can lead to permanent disabilities, but the care team will ensure that all efforts focus on restoring as much function and independence as possible. [3] The ultimate goal is to get the patient back to their baseline lifestyle with the least disability.

Final thoughts

Remember, stroke is preventable and treatable. Acquiring treatment fast is essential in preventing death and disability from stroke. If you believe you or a loved one are experiencing the symptoms of a stroke, please seek help immediately, BEFAST and call 911.



[1] Baptist Health: Bell’s Palsy vs. Stroke

[2] Mayo Clinic: Bell’s palsy symptoms and causes

[3] Mayo Clinic: Diagnosis and treatment

[4] CDC Centers for Disease Control and Prevention: Stroke signs and symptoms

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