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)
Symptoms
- 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
Causes
- MND
- Guillian-Barre Syndrome
- Polio
- Syringobulbia
- Brainstem tumours
- Myasthenia gravis
- Myotonic Dystrophy
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.
Symptoms
- 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