Bulbar palsy

Symptoms • dysphagia (difficulty in swallowing). • difficulty in chewing. • nasal regurgitation. • difficulty in handling secretions, including aspiration of liquids. • difficulty breathing (airway obstruction). • dysphonia (defective use of the voice, inability to produce sound due to laryngeal weakness). • dysarthria (difficulty in articulating words due to a CNS problem), such as slurred speech. Signs • flaccid paralysis, such as soft palate weakness (examined by asking the patient to say aah). • 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. In addition, there may be lower motor neuron lesions of the limbs. The ocular muscles are spared and this differentiates it from myasthenia gravis. == Causes ==

• Genetic: Kennedy's disease, syringobulbia, • Autoimmune: myasthenia gravis. == Mechanism ==

Bulbar palsy involves problems with function of the glossopharyngeal nerve (CN IX), the vagus nerve (CN X), the accessory nerve (CN XI), and the hypoglossal nerve (CN XII). == Diagnosis ==

Differential diagnosis In contrast, pseudobulbar palsy is a clinical syndrome similar to bulbar palsy but in which the damage is located in upper motor neurons 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. == Treatment ==

In patients with airway obstruction due to bulbar palsy, intubation may be used. This can be tracheal intubation or supraglottal intubation. == See also ==