Bulbar palsy

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Bulbar palsy
SpecialtyNeurology
SymptomsDysphagia, dysarthria, flaccid paralysis, muscle atrophy, drooling of saliva, reduced or absent gag reflex

Bulbar palsy refers to a range of different signs and symptoms linked to impairment of function of the glossopharyngeal nerve (CN IX), the vagus nerve (CN X), the accessory nerve (CN XI), and the hypoglossal nerve (CN XII). It is caused by a lower motor neuron lesion in the medulla oblongata, or from lesions to these nerves outside the brainstem. This may be caused by any of a number of genetic, vascular, degenerative, inflammatory, and other underlying conditions. It can be differentiated from pseudobulbar palsy. When there is airway obstruction, intubation is used.

Signs and symptoms[]

Symptoms[]

  • dysphagia (difficulty in swallowing).[1]
  • difficulty in chewing.
  • nasal regurgitation.
  • difficulty in handling secretions, including aspiration of liquids.[2]
  • difficulty breathing (airway obstruction).[2]
  • dysphonia (defective use of the voice, inability to produce sound due to laryngeal weakness).
  • dysarthria (difficulty in articulating words due to a CNS problem), such as slurred speech.[1]

Signs[]

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[]

Mechanism[]

Bulbar palsy involves problems with function of the glossopharyngeal nerve (CN IX), the vagus nerve (CN X), the accessory nerve (CN XI), and the hypoglossal nerve (CN XII).[1] These all emerge from pathways in the medulla oblongata.[1] A lower motor neuron lesion can impair their function.[5][1]

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 (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[]

In patients with airway obstruction due to bulbar palsy, intubation may be used.[2] This can be tracheal intubation or supraglottal intubation.[2]

See also[]

References[]

  1. ^ a b c d e f g h i j k l m n o p q Rea, Paul (2015). "5 - Hindbrain (Rhombencephalon)". Essential Clinical Anatomy of the Nervous System. Academic Press. pp. 91–98. doi:10.1016/B978-0-12-802030-2.00005-4. ISBN 978-0-12-802030-2.
  2. ^ a b c d Warrell, David A. (2020). "137 - Animals Hazardous to Humans: Venomous Bites and Stings and Envenoming". Hunter's Tropical Medicine and Emerging Infectious Diseases (10th ed.). Elsevier. pp. 966–987. doi:10.1016/B978-0-323-55512-8.00137-X. ISBN 978-0-323-55512-8.
  3. ^ Jones, Bronwyn (2008). "19 - Abnormalities of Pharyngeal Function". Textbook of Gastrointestinal Radiology (3rd ed.). Saunders. pp. 253–269. doi:10.1016/B978-1-4160-2332-6.50024-5. ISBN 978-1-4160-2332-6.
  4. ^ http://www.us.elsevierhealth.com/wilderness-medicine-9781437716788.html[permanent dead link][dead link]
  5. ^ "Bulbar Palsy". Palsy. Archived from the original on 2011-04-27.

External links[]

Classification
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