Bulbar and Pseudobulbar Palsy
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Bulbar Palsy

This condition refers to lesions in the motor nuclei of the medulla. It is so called, because the region of the brain is sometimes called the bulb of the brainstem. It consists of LMN signs in regions innervated by the facial (VII), glossopharyngeal (IX), Vagus (X) and hypoglossal (XII)


  • Palsy of:
    • Tongue
    • Facial muscles
    • Swallowing
  • Sign appear like LMN signs:
    • Flaccid, fasciculating tongue (‘bag of worms)
  • Jaw jerk is normal – shows trigeminal is still intact
  •  Speech may be quiet, hoarse or nasal


Pseudobulbar Palsy

This is actually more common than bulbar palsy. It results from bilateral lesion of UMN’s  of the muscles of the tongue (XII), face (VII), speech and swallowing (IX,X). Lesion is commonly in corticobulbar tracts.


  • Spastic tongue
  • Donald duck’ speech
  • Increased jaw jerk
  • Emotionally inappropriate responses:
    • Weeping/laughing out of context
    • Similar features are also seen in head injury
  • Gravelly voice
  • Stiff erect posture
  • Face may look ‘menacing’
  • Reduced rate of blinking


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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