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

ObjectiveThis 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 settingThis was a secondary analysis of data prospectively collected in the first 7 days of stroke admission for the Bergen NORSTROKE study.ParticipantsOf 5987 patients, a subgroup of 2293 with facial palsy were analysed for recovery, including 1954 with ischaemic stroke assessed for treatment effect.Main measurementsFacial palsy was assessed repeatedly at irregular intervals from admission using the National Institute of Health Stroke Scale.AnalysisPrevalence was summarised descriptively, and multifactorial logistic regression identified risk factors. The recovery was analysed with Kaplan-Meier curves and Cox models.ResultsFacial 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, 573 patients (25%) had fully recovered, while 1434 (63%) still had symptoms by day 7. Worse recovery was associated with more severe motor and sensory impairments. Intravenous thrombolysis was associated with better recovery.ConclusionsOur study provides a comprehensive analysis of post-stroke facial palsy, highlighting recovery patterns and the need for ongoing monitoring and rehabilitation.