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ANKI Neuro > [23] Bulbar Palsy > Flashcards

[23] Bulbar Palsy Flashcards

1
Q

What is bulbar palsy?

A

A range of different signs and symptoms linked to impairment of function of CN 9-12 due to LMN lesion in the medulla oblongata or lesions of the lower cranial nerves outside the brainstem

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2
Q

What parts of the oral cavity are required for speech?

A
  • Larynx
  • Pharynx
  • Palate
  • Tongue
  • Lips
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3
Q

As well as components of the oral cavity, what else is required for speech?

A

Controlled expiration to release air at appropriate speeds and volumes

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4
Q

Via what do the motor cortices send signals to initiate speech?

A

Corticobulbar tracts

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5
Q

What nerves are involved in speech production?

A
  • Vagal nerve (CN 10)
  • Facial nerve (CN 7)
  • Hypoglossal nerve (12)
  • Phrenic nerve
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6
Q

How are the motor aspects of speech co-ordinated?

A

By the extra-pyramidal system via the basal ganglia and the cerebellum

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7
Q

What are the two aspects of speech production (motor aspects)?

A
  • Phonation

- Articulation

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8
Q

What is phonation?

A

The production of sound as a result of the vocal cords in the larynx

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9
Q

What is articulation?

A

Contractions of the muscles of the various other structures involved in speech

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10
Q

Why is articulation important?

A

Muscle contractions change the sounds from the larynx to result in noises recognised as words

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11
Q

What are the types of causes of Bulbar palsy?

A
  • Genetic
  • Vascular causes
  • Degenerative diseases
  • Inflammatory/infective
  • Malignancy
  • Toxic
  • Autoimmune
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12
Q

What are the genetic causes of Bulbar palsy?

A
  • Kennedy’s disease

- Acute intermittent porphyria

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13
Q

Give 1 vascular cause of Bulbar palsy?

A

Medullary infarction

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14
Q

What are 2 degenerative disease that can cause Bulbar palsy?

A
  • Amyotrophic lateral sclerosis

- Syringobulbia

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15
Q

Give 3 infective/inflammatory causes of Bulbar palsy?

A
  • Guillain-Barre syndrome
  • Poliomyelitis
  • Lyme disease
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16
Q

Give 2 malignant causes of Bulbar palsy?

A
  • Brainstem glioma

- Malignant meningitis

17
Q

Give 2 toxic causes of Bulbar palsy?

A
  • Botulism

- Some scorpion and snake venom

18
Q

Give 1 autoimmune cause of Bulbar palsy?

A

Myasthenia gravis

19
Q

What are the potential presenting symptoms of Bulbar palsy?

A
  • Dysphagia
  • Difficulty in chewing
  • Nasal regurgitation
  • Slurring of speech
  • Difficulty in handling secretions
  • Choking on liquids
  • Dysphonia
  • Dyarthria
20
Q

What is dysphonia?

A

Defective use of the voice due to the inability to produce sounds due to laryngeal weakness

21
Q

What are the potential signs of Bulbar palsy?

A
  • Nasal speech lacing
  • Difficulty with consonants
  • Atrophic tongue with fasciculations
  • Dribbling
  • Weakness of soft palate
  • Normal or absent jaw jerk
  • Absent gag reflex
22
Q

How can strength of soft palate be assessed?

A

Ask patient to say ahhh

23
Q

How can true bulbar palsy be differentiated from myasthenia gravis?

A

There is sparing of the ocular muscles

24
Q

What investigations can be used to assess speech dysfunction?

A
  • Electromagnetic articulography

- Electropalatography

25
Q

What other tests can be used to assess underlying causes of Bulbar palsy?

A
  • Blood tests
  • Imaging of brain and brainstem (CT or MRI)
  • Electromyography
26
Q

What is the main differential for Bulbar palsy?

A

Pseudobulbar palsy

27
Q

What is pseudobulbar palsy?

A

A syndrome similar to Bulbar palsy but where the damage is in the UMN of the corticobulbar tracts in the mid-pons

28
Q

What usually causes pseudobulbar palsy?

A

Stroke

29
Q

What are some other disorders of articulation?

A
  • Cerebellar-ataxic
  • Hypokinetic
  • Hyperkinetic
30
Q

How is Bulbar palsy treated?

A

By treating the underlying cause and involving neurologists, SALT and dieticians

31
Q

What supportive measures can be used to treat Bulbar palsy?

A
  • Baclofen for spasticity
  • Anticholinergics for drooling
  • Treatment for aspiration pneumonia if needed
  • Attention to nutrition
32
Q

What are the potential complications of Bulbar palsy?

A
  • Poor dentition
  • Poor nutrition
  • Psychological dysfunction

ANKI Neuro (30 decks)

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