Bulbar palsy
Bulbar palsy refers to a range of different signs and symptoms linked to impairment of function of the glossopharyngeal nerve, the vagus nerve, the accessory nerve, and the hypoglossal nerve. It is caused by a lower [motor neuron lesion] in the medulla oblongata, or from lesions to these nerves outside the brainstem, and also botulism. 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 chewing.
- nasal regurgitation.
- difficulty in handling secretions, including aspiration of liquids.
- difficulty breathing.
- dysphonia.
- dysarthria, such as slurred speech.
Signs
- 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.
The ocular muscles are spared and this differentiates it from myasthenia gravis.
Causes
- Genetic: Kennedy's disease, acute intermittent porphyria.
- Vascular causes: medullary infarction, such as lateral or medial medullary infarction.
- Degenerative diseases: amyotrophic lateral sclerosis, syringobulbia, Wolfram syndrome.
- Inflammatory/infective: Guillain–Barré syndrome, poliomyelitis, Lyme disease.
- Cancer: brainstem glioma, malignant meningitis.
- Toxic: botulism, venom of bark scorpion, some neurotoxic snake venoms.
- Autoimmune: myasthenia gravis.