Bulbar and pseudobulbar palsy

Question 1

what the difference in pathology between a bulbar palsy and a pseudo bulbar palsy?

Answer 1

bulbar palsy is a LMN affecting CN 9, 10 and 12

pseudo bulbar palsy is caused by bilateral lesion affecting the corticobulbar tract running from the motor cortex to the motor nuclei of CN 9, 12 and 12

Question 2

what the difference in the presentation of a bulbar palsy vs pseudo bulbar palsy?

Answer 2

bulbar = LMN

• flaccid fascinating tongue
• absent jaw jerk reflex
• absent gag reflex
• nasal quiet speech

pseudo bulbar = UMN

• brisk jaw jerk reflex
• slow thick speech
• spastic tongue
• emotional lability

Question 3

what are the causes of a bulbar palsy?

Answer 3

motor neurone disease 
brainstem stroke - lateral medullary syndrome 
myasthenia graves 
Gillian barre syndrome
syringobulbia

Question 4

what are the causes of a pseudo bulbar palsy?

Answer 4

vascular - bilateral internal capsule stroke
autoimmune - multiple sclerosis
degenerative - motor neurone disease, progressive supra nuclear palsy
neoplasm - brainstem tumours