Pseudobulbar palsy: Difference between revisions
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=== Clinic === | === Clinic === | ||
* It is a | * It is a disease characterized by the inability to control facial movements (such as chewing and speaking) and slurred speech | ||
* | * Main pathologic core is [[UMN Pathways|Corticobulbar pathways]], which originate from cerebral cortex and go to cranial nerves nuclei in [[brainstem]] (Bulbar region) | ||
* It has bilateral supranuclear (UMN) lesions of lower cranial nerves producing weakness of the tongue and pharyngeal muscles. | |||
* It resembles, superficially to bulbar palsy but it is pseudobulbar | |||
* | |||
=== Signs / Symptoms === | === Signs / Symptoms === | ||
* | * [[Pseudobulbar affect]] /Labile affect | ||
* Dysphagia | * [[Dysphagia]] | ||
* Brisk [[jaw jerk]] | * Brisk [[jaw jerk]] | ||
* Dysarthria | * [[Dysarthria]] /Slow and indistinct speech | ||
* Gag reflex may be normal, exaggerated or absent | * Gag reflex may be normal, exaggerated or absent | ||
* [[ | * Difficulty chewing | ||
* Tongue spasticity: Small, stiff and spastic tongue | |||
* [[UMN, Upper Motor Neuron|UMN]] lesion of the limbs | |||
=== Causes === | === Causes === | ||
{| class="wikitable" | |||
!Dynamic | |||
!Static | |||
|- | |||
| | |||
* [[Progressive supranuclear palsy]] | * [[Progressive supranuclear palsy]] | ||
* Parkinson's disease | |||
* [[Multiple system atrophy|MSA]] | |||
* [[ALS, Amyotrophic Lateral Sclerosis remedies|ALS]] | * [[ALS, Amyotrophic Lateral Sclerosis remedies|ALS]] | ||
* | * Neurological involvement in [[Behcet disease]] | ||
* | * Desalinating disease | ||
* MS | * [[MS, Multiple Sclerosis|MS]] | ||
| | |||
* High brain stem tumors | * High brain stem tumors | ||
* Metabolic causes | * Vascular causes such as | ||
* Bilateral hemisphere infarction | |||
* CADASIL syndrome | |||
* Artery of percheron infarct | |||
* Metabolic causes (Osmotic demyelination syndrome) | |||
* Brain trauma | * Brain trauma | ||
|} | |||
Pseudobulbar palsy is the result of damage of motor fibers traveling from the cerebral cortex to the lower brain stem. This damage might arise in the course of a variety of neurological conditions that involve demyelination and bilateral corticobulbar lesions including: | |||
| Line 43: | Line 48: | ||
* The proposed mechanism of pseudobulbar palsy points to the disinhibition of the motor neurons controlling laughter and crying, proposing that a reciprocal pathway exists between the cerebellum and the brain stem that adjusts laughter and crying responses, making them appropriate to context. T | * The proposed mechanism of pseudobulbar palsy points to the disinhibition of the motor neurons controlling laughter and crying, proposing that a reciprocal pathway exists between the cerebellum and the brain stem that adjusts laughter and crying responses, making them appropriate to context. T | ||
* Pseudobulbar crying could also be induced by stimulation in the region of the subthalamic nucleus of the brain. | * Pseudobulbar crying could also be induced by stimulation in the region of the subthalamic nucleus of the brain. | ||
=== Entities === | === Entities === | ||
| Line 49: | Line 55: | ||
* Dysarthria / Speech difficult | * Dysarthria / Speech difficult | ||
* Emotional lability / [[Pseudobulbar affect]] | * Emotional lability / [[Pseudobulbar affect]] | ||
* Hyper | * Hyper Reflexia | ||
* Spasm | * Spasm | ||
=== Miasms === | === Miasms?? === | ||
GSS <ref>Zhao MM, Feng LS, Hou S, Shen PP, Cui L, Feng JC. Gerstmann-Sträussler-Scheinker disease: A case report. World J Clin Cases. 2019 Feb 6;7(3):389-395. doi: 10.12998/wjcc.v7.i3.389. PMID: 30746381; PMCID: PMC6369391.</ref> | GSS <ref>Zhao MM, Feng LS, Hou S, Shen PP, Cui L, Feng JC. Gerstmann-Sträussler-Scheinker disease: A case report. World J Clin Cases. 2019 Feb 6;7(3):389-395. doi: 10.12998/wjcc.v7.i3.389. PMID: 30746381; PMCID: PMC6369391.</ref> | ||
Revision as of 23:06, 13 April 2023
Clinic
- It is a disease characterized by the inability to control facial movements (such as chewing and speaking) and slurred speech
- Main pathologic core is Corticobulbar pathways, which originate from cerebral cortex and go to cranial nerves nuclei in brainstem (Bulbar region)
- It has bilateral supranuclear (UMN) lesions of lower cranial nerves producing weakness of the tongue and pharyngeal muscles.
- It resembles, superficially to bulbar palsy but it is pseudobulbar
Signs / Symptoms
- Pseudobulbar affect /Labile affect
- Dysphagia
- Brisk jaw jerk
- Dysarthria /Slow and indistinct speech
- Gag reflex may be normal, exaggerated or absent
- Difficulty chewing
- Tongue spasticity: Small, stiff and spastic tongue
- UMN lesion of the limbs
Causes
| Dynamic | Static |
|---|---|
|
|
Pseudobulbar palsy is the result of damage of motor fibers traveling from the cerebral cortex to the lower brain stem. This damage might arise in the course of a variety of neurological conditions that involve demyelination and bilateral corticobulbar lesions including:
Pathophysiology
- The proposed mechanism of pseudobulbar palsy points to the disinhibition of the motor neurons controlling laughter and crying, proposing that a reciprocal pathway exists between the cerebellum and the brain stem that adjusts laughter and crying responses, making them appropriate to context. T
- Pseudobulbar crying could also be induced by stimulation in the region of the subthalamic nucleus of the brain.
Entities
- Dysphagia
- Dysarthria / Speech difficult
- Emotional lability / Pseudobulbar affect
- Hyper Reflexia
- Spasm
Miasms??
GSS [1]
- ↑ Zhao MM, Feng LS, Hou S, Shen PP, Cui L, Feng JC. Gerstmann-Sträussler-Scheinker disease: A case report. World J Clin Cases. 2019 Feb 6;7(3):389-395. doi: 10.12998/wjcc.v7.i3.389. PMID: 30746381; PMCID: PMC6369391.