Bulbar Palsy

Question 1

Definition

Answer 1

Lower motor neurone lesions affecting cranial nerves IX, X, and XII resulting in impairments in speech and swallowing

Question 2

Epidemiology

Answer 2

50-70 years

Question 3

Aetiology

Answer 3

• Motor neurone disease
• Myasthenia gravis
• GBS
• Brainstem stroke
• Syringobulbia - fluid filled cavity (syrinx) within the spinal cord
• Tumours

Question 4

Symptoms

Answer 4

• Absent or normal jaw jerk reflex
• Absent gag reflex
• Flaccid, fasciculation tongue (‘bag of worms’)
• Nasal speech, often described as “quiet”
• Limb fasciculations
• Difficulty swallowing

Question 5

Diagnosis

Answer 5

Neurological examination: To assess CN integrity
EMG: MND, MG Dx
Blood tests: blood count, electrolytes, CK, autoantibody screening
MRI: syrinx Dx
LP: Infection/AI causes

Question 6

DDx

Answer 6

Pseudobulbar palsy - UMN lesion of CN
= dysarthria
= dysphagia
= emotional liability
Brainstem tumour
MS
Polymyositis

Question 7

Treatment

Answer 7

Speech and swallowing therapy
Nutrition support: dysphagia causes impaired nutritional intake
Pharmacological treatments: based on underlying condition e.g. immunosupression for myasthenia gravis
Regular monitoring: assess progression and manage emerging complications.