Bell palsy vs facial palsy due to stroke
The two most common causes of acute facial paralysis are Bell’s palsy and ischemic stroke or upper motor type of facial paralysis.
Facial weakness can be caused by strokes in many different locations in the brain and brainstem. Strokes involving the brain typically cause central facial weakness that involves the mouth and spares the eye and forehead.
Strokes involving the brainstem can sometimes cause weakness of the mouth, eye and forehead–mimicking a peripheral lesion. In these cases however, there will be other focal neurologic deficits. A review of systems and neurologic examination can help to identify signs and symptoms of stroke.
Bell’s palsy is a condition that causes sudden weakness in the muscles on one side of the face. In most cases, the weakness is temporary and significantly improves over weeks.
The weakness makes half of the face appear to droop. Smiles are one-sided, and the eye on the affected side resists closing.
Bell palsy vs facial palsy due to stroke
Topic | Upper motor type/ stroke | Lower motor type/ bell’s palsy | |
Age | >60 years | 20 -50 | |
Time course | Second to minutes | Few hours to few days | |
Upper face | Usually not affected | Affected | |
Lower face | Affected | Affected | |
Associate symptoms | • Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days • Facial droop and difficulty making facial expressions, such as closing your eye or smiling • Drooling • Pain around the jaw or in or behind your ear on the affected side • Increased sensitivity to sound on the affected side • Headache • A loss of taste • Changes in the amount of tears and saliva you produce
| stroke causing isolated left lower facial weakness. There’s a flattened nasolabial fold & inability to smile on the affected side with sparing of the forehead & eye closure muscles. Weakness or numbness in the arm or leg: Weakness or numbness can occur either on the same side as the facial palsy, or on the opposite side, Difficulty swallowing (dysphagia): Dysphagia secondary to brainstem ischemia | |
Clinical anatomy of scalp
1. Which layers of scalp is known as dangerous layer of scalp?
· 4th layer, the subaponeurotic layer of scalp is known as dangerous layer of scalp.
· Why ?
· Due to loose spaces blood and pus tent to collect in this space and this space contain emissary veins which connect veins of scalp to the venous sinuses of cranium. So infection from this layer spread into the venous sinuses of cranium.
2. Functional importance of sub aponeurotic layer of scalp
· In case children injury of vault, blood from intra cranial hematoma accumulate in 4th layer of scalp, so no sign of intracranial pressure rise was seen
3. Why bleeding under surface of periosteum of skull bone cause cephalohaematoma
It is a hemorrhage of blood between the skull and the periosteum of particular skull bones. It is a typically harmless condition that causes blood to pool under a newborn’s scalp after a difficult vaginal delivery. Periosteum of skull bone, the innermost layer of scalp is loosely attach to bone except near the suture, so hemorrhage below this layer make shape of individual bone. It is more see in parietal region.
4. Why a blow on head lead to “black eye’ ?
· Injury of the scalp causes collection of blood into the 4th layer of scalp, the sub-aponeurotic layer of scalp. Frontalis muscle which cover part of forehead of scalp has no bony attachment and due to gravity blood accumulated in the scalp go downward and accumulate under the eye.
5. After scalp injury, why blood accumulate under the eye but not goes laterally and posteriorly.?
· The epicranial aponeurosis of scalp and occipitalis muscles have bony attachments to superficial temporal lines and superior nuchal lines, so blood cannot go laterally and posteriorly but frontalis muscle has no bony attachment so blood always track downward and settle under the eye.
6. Why wounds of scalp bleed profusely?
· It has two causes
· The scalp is rich in blood supply
· For epicranial aponeurosis (or galea aponeurotica) which is a tough layer form by dense fibrous tissue and scalp blood vessel adhere with it which prevent vasocontriction , so scalp injury bleed more.
7. Why transverse scalp injury tend to create more gap?
Ans Epicranial aponeurosis (or galea aponeurotica), the 2nd layers of the scalp which is a tough layer made by dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly. So there is a tension present within the epicranial aponeurosis from anterior posteriorly. So a large gap is created when injury occur in transversely but injury occur in anterior posterior direction is not followed by large gap.
8. Caput succedaneum is swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery.
9. Clinical anatomy of Caput succedaneum
It is swelling due to collection of fluid in the 4th layer(loose areolar tissue) of scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. It is subsides with 1-2 days
