Post-stroke facial palsy: Prevalence, recovery patterns within the first 7 days, risk factors, and effect of hyperacute treatments

Abstract

Objective: This study estimated the prevalence of facial palsy after stroke and identified risk factors; examined recovery patterns; and evaluated the effect of hyperacute treatments on its recovery. Design and setting: This was a secondary analysis of data prospectively collected in the first 7 days of stroke admission for the Bergen NORSTROKE study. Participants: Of 5987 patients, a subgroup of 2293 with facial palsy were analysed for recovery, including 1954 with ischaemic stroke assessed for treatment effect. Main measurements: Facial palsy was assessed repeatedly at irregular intervals from admission using the National Institute of Health Stroke Scale. Analysis: Prevalence was summarised descriptively, and multifactorial logistic regression identified risk factors. The recovery was analysed with Kaplan–Meier curves and Cox models. Results: Facial palsy was observed in 2578 patients (43%), including 2406 (40%) with minor or partial paralysis and 172 (3%) with complete paralysis. Facial palsy was more common in haemorrhagic (360, 54%) than ischaemic stroke (2218, 42%), reflecting greater motor impairment. Among patients without motor impairment, prevalence was lower in haemorrhagic strokes (15, 10%) than in ischaemic strokes (284, 14%). Risk factors included sex, age, and the degree of motor and sensory deficit. By day 2, 2573 patients (25%) had fully recovered, while 1376 (60%) still had symptoms by day 7. Worse recovery was associated with more severe motor and sensory impairments. Intravenous thrombolysis was associated with better recovery. Conclusions: Our study provides a comprehensive analysis of post-stroke facial palsy, highlighting recovery patterns and the need for ongoing monitoring and rehabilitation.