Ok, I realize I’m not a doctor and that self-diagnosis via the beautiful interwebs is not exactly the wisest move to make but in this case it’s not self-diagnosis. I simply like to further educate myself when it comes to my stroke related issues. Today I decided to educate myself on facial paralysis.
4 or 5 days ago, give or take a day, for whatever reason, I swiped my hand under my nose. There was an embarrassing amount of snot on the back of my hand. I washed my hand and stuck a mental memo to the inside of my skull and hoped to remember this if anything else odd crossed me. A day or two later I tasted salt out of nowhere. My left eye was “leaking” as if just that one eye was under an allergy attack. We had pizza for dinner one night and I couldn’t feel the blob of sauce sitting in the corner of my mouth until it got cold which is actually really gross. Then it was rice; it kept falling out of the left side of my mouth. Last night it was spaghetti. I couldn’t keep the noodles in my mouth or feel them getting cut out in a bite until the noodle landed on my lap or on the table. I have been reasonably lucky in that all that happened to my face during the stroke has pretty much recovered on its own. I only slur when I get nervous or excited and I have just enough feeling in that side of my face to make living with this face bearable though I may not always feel you slap me (ha!). I may have some peripheral issues with my vision but that field is slowly gaining ground so I’m okay with it. To suddenly find myself having difficulty with keeping food in my mouth and not feeling things like tears after regaining those abilities back is slightly disturbing. I have not found out why this is happening but I did find out a thing or two about facial paralysis associated with stroke.
It’s not Bell’s Palsy
- I actually feel kind of stupid on this one but I have a decent excuse: other stroke survivors say their stroke caused Bell’s Palsy
I never really thought what was going on with my face was Bell’s Palsy in the first place. First of all, it “healed” within six weeks to 2 months with minimal lingering effects so I felt this was too definitive a term for what I was experiencing. But it somehow made sense that since my symptoms aligned with other survivors, maybe I had some weak form of Bell’s Palsy.
Bell’s Palsy is a condition where one half of the face is paralysed and cannot be controlled voluntarily. There are many causes for facial paralysis but one thing is for certain, if you can find the cause for the facial paralysis, it’s definitely not Bell’s Palsy. According to various sites and definitions, Bell’s Palsy is most commonly diagnosed by exclusion; meaning, when your face droops and every possible cause from infection to stroke has been ruled out, it’s Bell’s Palsy. There is no known cause for Bell’s Palsy but there are treatments. From what I read, it reaches its peak in about 3 weeks and can last for 6 months or more. About 90% of people experiencing Bell’s Palsy will recover with some beginning to recover within days, even without treatment.
- Interesting fact: It is believed that most cases of Bell’s Palsy is caused by some sort of infection with Herpes Simplex Virus (HSV) being on top of that list. Other diseases associated with Bell’s Palsy are also closely related to or associated with Herpes. Some of these include: Shingles, chicken pox, and Epstein-Barr (mononucleosis).
Facial Nerve Paralysis
- Central Facial Palsy/Facial Weakness
After discovering quite quickly that I have never had Bell’s Palsy I started to look at the most common form of facial paralysis associated with stroke. I learned that most stroke survivors “suffer” from what is known as Central Facial Palsy. Central Facial Palsy is usually the result of damage to the motor strip located in the posterior (back or tail end) of the frontal lobe. This is defined by weakness or paralysis to typically only the lower portion of the face. The patient will most likely be able to move their eyes (closing tightly), their brows and forehead ( wiggling) while their mouth may be limited to a weak smile and possibly left with little feeling, numbness or the inability to correctly identify heat from cold (similar to hemiparesis and other forms of paralysis) on that side of the face. My AVM ruptured in or near the central sulcus which is basically the line that separates the frontal lobe from the parietal lobe. This fissure also separates the motor cortex from the somatosensory cortex. This explains why I have little to no physical understanding of touch, pain, or distinction between temperatures (somatosensory cortex) as well as little to no voluntary control (motor cortex) of my left body . This neat little article lays it out pretty cleanly. If you’ve experienced damage to the motor cortex, most likely you will experience contralateral (opposite side) facial weakness or central facial palsy. If the facial nerve in the brain stem or the pons was damaged, the facial palsy or weakness would be ipsilateral (same side). The best way to identify the source of the facial palsy is to include other factors presented with the patient such as how much of the face is weak (Bell’s Palsy is always all of one side while stroke is typically limited to the lower portion), weak limbs, and vertigo. Vertigo is not directly associated with Bell’s Palsy but there are many other sicknesses and associative conditions that may cause facial weakness (like brain stem stroke or lesions).
I may not know what is going on with my face lately but at least I know it’s not Bell’s Palsy. Considering I have had motion sickness and increased neck pain lately, I will have to bring this to my doctors attention. I kind of would prefer Bell’s Palsy, at least I would know it would stop at some point or can be treated but my face is not at all drooping, just a little more out-of-touch than what has become normal.