Facial paralysis Is it a stroke?

Facial paralysis: stroke or facial paralysis?

04/16/2014

Half-sided paralysis of the face causes most people to involuntarily think of a stroke, but behind the symptoms a so-called facial palsy can be concealed. This facial paralysis is caused by a malfunction of the facial nerve, which in turn can have a variety of causes. However, a medical examination of the symptoms is always required.

Often the symptoms of facial paresis are relatively sudden. The facial muscles appear partially or completely paralyzed, those affected can not close their mouths properly, hang the corners of their mouths, the forehead can not be wrinkled and the eyelid does not close properly. The Naserümpfen also is not possible and the affected suffer from time to time „Discomfort on the cheek or a feeling of pressure on the ear“, cited „Mirror online“ the specialist Josef Heckmann of the German Society of Neurology (DGN). Disorders of the sense of taste and hypersensitivity to noises are also possible symptoms. However, since a layman can not tell whether the complaints are due to a stroke or a facial paralysis, according to the expert, an emergency doctor should be alerted immediately

Facial paralysis is due to a malfunction of the facial nerve, which leaves the brainstem, leaves the base of the skull in the region of the temporal bone behind the earlobe, runs through the salivary gland and then spreads out in fine branches across the face, explained the specialist for neurology and senior physician at the University Hospital Hamburg-Eppendorf, Günther Thayssen, in the „Mirror online“-Items. The nerve supplies, among other things, the mimic muscles, parts of the salivary glands and the lacrimal glands. Also, it is necessary for the sense of taste in the front of the tongue. Accordingly, the symptoms may be due to a functional disorder of the seventh cranial nerve.

75 percent of facial nerve pareses with no apparent physical cause
Differences between the so-called „peripheral facial palsy“ (Damage to parts of the facial nerve), the „central facial paresis“ (central nerve damage in the brain) and the „idiopathic facial palsy“ (no physical cause recognizable). According to the experts, the latter applies to around 75 percent of cases. About 25 out of 100,000 people suffer from this most common cranial nerve disease each year. The other 25% of facial nerve pareses include, for example, infections with viruses (eg chickenpox virus, Epstein-Barr virus) or bacteria (eg Mycobacterium tuberculosis, Borrelia), autoimmune diseases of the nervous system (eg Guillain-Barré syndrome), injuries (eg fractures) and tumors.

Herpes simplex virus as a trigger in the discussion
The idiopathic paralysis of the facial nerve is still not a clear physical cause, but according to the DGN expert Heckmann is discussed in the scientific community, whether possibly a reactivated herpes simplex virus can trigger the paralysis. The inflammatory processes occurring in the context of such a reactivated infection could, according to theory, cause swelling of the facial nerve in the narrow bony facial canal. As a result, the nerve would be pinched and disturbed in its function. „We know that the nerve is swollen and the circulation can be reduced“, emphasized Josef Heckmann.

Comprehensive investigations required
As soon as the ambulance arrives, he will first check if there is a stroke. If this is not the case, further specialist medical examinations will be carried out, which will search for injuries, tumors and cerebral hemorrhages with the help of imaging techniques such as computed tomography or magnetic resonance tomography. A blood test provides indications of possible inflammatory processes and infections. Also a so-called „lumbar puncture“, in the „Cerebrospinal fluid removed and examined“ can be required for diagnosis, explained the DGN expert. If a physical cause of facial nerve palsy can be determined, then the subsequent therapy depends on it.

Therapeutic treatment of facial paralysis usually unavoidable
In general, facial nerve paralysis usually requires treatment, since incomplete eyelid closure threatens desiccation of the cornea of ​​the eye, which in turn can cause inflammation of the eye. Therefore, sufferers should, according to Josef Heckmann „diligently maintain the eye with a dexpanthenol ointment.“ A so-called watch glass bandage can also protect the eye overnight. Furthermore, according to the specialist, cortisone tablets should be taken for around ten days. Complementary facial massages and facial expressions could have a positive effect on the healing process. Concerned also report a promising effect of lymphatic drainage. According to the experts, the idiopathic facial paresis occurs in about 80 percent of the patients after a maximum of eight weeks, depending on the extent of the functional impairment. However, the remaining patients often suffer significantly longer and may show permanent paralysis of the facial nerve. Here, in the worst case, an operation must be considered, in particular to make the eyelid again, explained Günther Thayssen. (Fp)