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Q. Can stroke cause facial droop in the lower half of the left side of my face?

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Feb 18, 2020

Hi doctor,

I am 34 years old and I have facial droop in the lower half of the left side of my face. It has been with me for years. I would not call it a paralysis or bells palsy as I have full control of my forehead and eyebrows, but the lower part when I talk it is noticable that the lip from the left side is way lower, and the nose as well seems lower from one side. I was wondeing what this could be, all the searches online say stroke but I am young and never had any symptoms of stroke, so what else could it be? And what would you advise me to do?

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#

Hello,

Welcome to icliniq.com.

I would like to know some details about your symptoms:

1. When, first time, you noticed facial drop in left lower half face?

2. Did it happen suddenly? Or it happened slowly and gradually?

3. Did you had any weakness in left arm/ hand / left leg along with?

4. Had you any change in voice that time?

5. Have you ever undergone some tests for its evaluation?

6. Have you any symptom in left ear: hearing difficulty/ ear discharge/ hearing abnormal sound?

7. Have you any other significant medical history (apart from this facial droop)?

8. At what time this facial droop is most noticeable: at normal forward face look? while smiling? while speaking? while eating? while laughing?

9. Have you any difficulty in swallowing?

Revert with above mentioned information and also I suggest to make a short video of your face (in normal/ smiling/ speaking/ laughing) and upload here as attachment.


Investigations to be done:

MRI Brain
ENT (ear) examination
serum ACE level
viral markers (HIV/ HBsAg/ Anti HCV antibodies)
NCV bilateral facial nerve

Thank you doctor,

1. I knew it by coincidence from a dermatologist 6 years ago who told me that there is some sort of assymetry in my face. It might have started even before but i dont notice it when I look at my self in the mirror.

2. As mentioned in the previous answer I knew it by coincidence so I am not really sure. 3. No 4. No 5. I have done tests less than a year ago not for the sake of its evaluation but as part as part of a check up (HIV, Syphylis , Hep B, Hep C all negative) 6. No 7. I have sinus issues and nasal septum deviation.

8. Generally, because of my nasal deviation I get a feeling that it is noticeable when looking at the nose at normal forward face look, the lip as well but the lip assymetry is more noticeable when I talk only. Smiling and eating is normal.

9. No.

#

Hello,

Welcome back to icliniq.com.

By looking at your short video (attachment removed to protect patient identity), your lips/ nasolabial folds look bilaterally equal and symmetrical. Facial droop is not noticeable. I would like to know:

Has it improved with time (after dermatologist pointed out about it)? It is persistently same as of that time? It has worsened with time? It is good that your tests (HIV/ HBsAg, Anti HCV, Syphilis were negative).


Investigations to be done:

MRI Brain,
NCV bilateral facial nerve

Differential diagnosis:

1. Previous bells's palsy, which might have improved now.
2. It may be normal structure of your face like this only.

Probable diagnosis:

1. Previous bells's palsy, which might have improved now.
2. It may be normal structure of your face.

Regarding follow up:

Revert with above information and get the mentioned tests to rule out any brain pathology & to look for facial nerve conductions.


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