Bulbar palsy

Clinic

• It refers to a range of different Signs / Symptoms linked to impairment of function of
  1. Glossopharyngeal nerve (CN IX)
  2. Vagus nerve (CN X)
  3. Accessory nerve (CN XI)
  4. Hypoglossal nerve (CN XII)
• 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

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

Related Disease

• 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.

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

Miasms

• CXA
• EV70
• PLV