Bulbar palsy

Clinic

• Bulbar palsy is an entity which involve cranial nerves 9,10,11,12
  1. Glossopharyngeal nerve (CN IX)
  2. Vagus nerve (CN X)
  3. Accessory nerve (CN XI)
  4. Hypoglossal nerve (CN XII)
• Motor Neuron Diseases have this entity
  • Progressive bulbar palsy
  • Pseudobulbar palsy

• It is caused by a Lower motor neuron lesion in medulla oblongata, or from lesions to these nerves outside brainstem.

Signs /Symptoms

Symptoms	Signs
Dysphagia Difficulty in chewing Nasal regurgitation Difficulty in handling secretions, including aspiration of liquids Difficulty breathing (Airway obstruction) Dysphonia (Inability to produce sound due to laryngeal weakness) Dysarthria ( such as slurred speech. May be LMN lesions of the limbs.	Flaccid paralysis, such as soft palate weakness Muscle atrophy, such as tongue atrophy with fasciculations. Nasal speech lacking in modulation and difficulty with all consonants. Drooling of saliva Normal or absent jaw jerk Reduced or absent gag reflex

Causes

Dynamic	Static
Degenerative diseases: ALS, Syringobulbia, Wolfram syndrome Inflammatory/ Infective: Guillain–Barré syndrome PLV Lyme disease Autoimmune: Myasthenia gravis	Genetic: Kennedy's disease, Acute intermittent porphyria. Vascular causes: medullary infarction Cancer: Brainstem glioma, Malignant meningitis Toxic: botulism, venom of bark scorpion

Entities / Miasms

	PLV	CXA	EV70	CJD	NVCJD	FFI
Paralysis, Bulbar	+++	+++	+++
Dysarthria Mouth/ Speech difficult / Speech nasal Nasal speech	+++			+++	+++	+++
Dysphagia	+++			+++	+++	+++
Face, Plasy	+++
LMN: Softe palate paralysis Muscular atrophy Fasciculations Hypo Reflexia	+++

Related disease

• GERD
• Motor Neuron Disease
• Progressive bulbar palsy
• Myasthenia gravis:The ocular muscles are spared Bulbar Palsy and this differentiates it from MG.
• Pseudobulbar palsy: Pseudobulbar palsy is a clinical syndrome similar to bulbar palsy but in which the damage is located in UMN 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.

Miasms

• PLV: It is the most important miasm
• CXA
• EV70