Stroke vs Bell Palsy — ORE Part 1 MCQ

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HardOral MedicineStroke vs Bell PalsyORE Part 1

A 55-year-old man presents with sudden onset right-sided facial weakness. He cannot raise his right eyebrow, close his right eye, or smile on the right side. He also has right arm weakness and slurred speech. What is the most likely diagnosis?

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Correct answer: A — Stroke (upper motor neuron lesion)

The diagnosis is stroke. The patient presents with the classic FAST-positive triad: facial weakness (including inability to raise the eyebrow, indicating upper facial involvement), arm weakness, and speech disturbance. These simultaneous deficits indicate acute upper motor neuron pathology (central) rather than peripheral facial nerve disease. Bell palsy (option B) is a peripheral lower motor neuron condition that presents as isolated facial weakness without arm or speech involvement; the accompanying arm weakness and dysarthria exclude this diagnosis. Ramsay Hunt syndrome (option C) requires vesicular rash in the ear or palate—not mentioned. The forehead weakness in this case does not exclude stroke; recent evidence shows upper facial involvement is common in acute ischemic stroke, especially in severe cases with concurrent limb weakness. Parotid tumour (option D) and TMD (option E) are implausible in acute presentation with systemic neurological deficits.

Reference: NHS Act FAST campaign (2024–2025) and Scottish Emergency Department Guidance on Bell's Palsy (2015); supported by recent peer-reviewed analysis (2025) of upper facial weakness in central facial palsy post-stroke in Neurology International. https://www.rightdecisions.scot.nhs.uk/media/3316/bells-palsyajc.pdf