Pseudobulbar palsy

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
Progressive supranuclear palsy Parkinson's disease MSA ALS Neurological involvement in Behcet disease Desalinating disease MS	High brain stem tumors Vascular causes such as Bilateral hemisphere infarction CADASIL syndrome Artery of percheron infarct Metabolic causes (Osmotic demyelination syndrome) 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:

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