| Bulbar palsy | |
|---|---|
| Specialty | Neurology  |
Bulbar palsy refers to a range of different signs and symptoms linked to impairment of function of the cranial nerves IX, X, XI, XII, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem.[1]
Signs and symptoms
Symptoms
- dysphagia (difficulty in swallowing)
- difficulty in chewing
- nasal regurgitation
- slurring of speech
- difficulty in handling secretions
- aspiration of liquids
- dysphonia (defective use of the voice, inability to produce sound due to laryngeal weakness)
- dysarthria (difficulty in articulating words due to a CNS problem)
Signs
- nasal speech lacking in modulation and difficulty with all consonants
- tongue is atrophic and shows fasciculations.
- dribbling of saliva.
- weakness of the soft palate, examined by asking the patient to say aah.
- normal or absent jaw jerk
- absent gag reflex
In addition, there may be lower motor neuron lesions of the limbs.
The ocular muscles are spared and this differentiates it from myasthenia gravis.
Causes
- Genetic: Kennedy's disease, acute intermittent porphyria
- Vascular causes: medullary infarction, such as lateral or medial medullary infarction.
- Degenerative diseases: amyotrophic lateral sclerosis, syringobulbia, Wolfram syndrome
- Inflammatory/infective: Guillain–Barré syndrome, poliomyelitis, Lyme disease
- Malignancy: brain-stem glioma, malignant meningitis
- Toxic: botulism, venom of bark scorpion (species Centruroides),[2] some neurotoxic snake venoms[3]
- Autoimmune: myasthenia gravis
Diagnosis
Differential diagnosis
In contrast, pseudobulbar palsy is a clinical syndrome similar to bulbar palsy but in which the damage is located in upper motor neurons of the corticobulbar tracts in the mid-pons (i.e., in the cranial nerves IX-XII), that is the nerve cells coming down from the cerebral cortex innervating the motor nuclei in the medulla. This is usually caused by stroke.
Treatment
Depends on diagnosis
See also
References
- ^ "Bulbar Palsy". Palsy. Archived from the original on 2011-04-27.
- ^ http://www.us.elsevierhealth.com/wilderness-medicine-9781437716788.html
- ^ http://www.us.elsevierhealth.com/wilderness-medicine-9781437716788.html
External links
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