‘Precursory symptoms, awareness or progression of facial palsy’ are more useful than ‘forehead wrinkling ability’ in differentiating central facial palsy examined in the emergency department

Abstract

Background

Forehead wrinkling ability has been considered to be the sign of the central facial palsy (CFP).

Aims/Objectives

To identify characteristics of peripheral FP (PFP) patients in the emergency room (ER), differentiate PFP from central FP (CFP), and assess the utility of forehead wrinkling for this purpose.

Materials and Methods

ER patients with FP were clinically split into PFP (72 patients) and CFP (161 patients) groups. Factors like age, sex, medical history, time from onset to consultation, symptom awareness or progression, precursory symptoms, forehead wrinkling, and imaging history were compared. Multivariate analysis differentiated PFP from CFP, examining misdiagnosis risks based on forehead wrinkling.

Results

Precursory symptoms and symptom awareness or progression had the highest odds ratios. Some PFP patients could wrinkle their foreheads, typically examined within 1 day of symptoms. PFP patients had more same-day imaging than those assessed a day later.

Conclusions and Significance

Forehead wrinkling, a traditional CFP sign, is also common in early-stage PFP, decreasing its diagnostic reliability. Patients with solely CFP unable to wrinkle the forehead are very rare at a single institution. Evaluating precursors symptoms, and FP awareness and progression is crucial for differentiation.

Chinese Abstract

背景：前额起皱能力被认为是中枢性面瘫（CFP）的标志。

目的：确定急诊室 (ER) 外周 FP (PFP) 患者的特征, 区分 PFP 和中枢性 FP (CFP), 并评估前额起皱用于此目的的效果。

材料和方法：急诊室 FP患者在临床上分为 PFP组（72 名患者）和 CFP组（161 名患者）。 比较了年龄、性别、病史、发病至就诊时间、症状意识或进程、前兆症状、前额起皱和影像学史等因素。用多变量分析来区分 PFP 和 CFP, 根据前额起皱检查误诊风险。

结果：先兆症状和症状意识或进展的比值比最高。一些 PFP 患者的额头可能会起皱, 通常在出现症状后 1 天内进行检查。 PFP患者当天接受的影像检查比一天后接受检查的患者的影像要多。

结论及意义：前额起皱是CFP的传统标志, 但也很常见于早期PFP, 因此降低了其诊断可靠性。 仅患有 CFP 而前额无法起皱的患者在单个医院中很少见。 为了区分两者, 评估先兆症状以及 FP 意识和进程至关重要。

Keywords:

• Facial palsy
• forehead wrinkling ability
• emergency department
• central facial palsy

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Author contributions

The study protocol was developed by OS. OS, YY, and YR collected the data. OS conducted data analysis and wrote the manuscript draft. WK performed manuscript editing. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).