bulbar palsy

Question 1

what is bulbar palsy

Answer 1

LMN palsy that affects the nuclei of the 9, 10, 11, 12 CNs

Question 2

what is pseudobulbar palsy

Answer 2

UMN palsy that affects the corticobulbar tracts of the 5, 7, 9, 10, 11, 12 CNs

Question 3

how to differentiate between bulbar and psuedobulbar palsy

Answer 3

as bulbar LMN it will have signs such as fasciculations of the tongue and absent gag reflex

as pseduobulbar is UMN will have signs such as jaw jerk reflexes, exaggerated gaga, spastic tongue

Question 4

clinical features of bulbar palsy

Answer 4

normal facial expression
speech - nasal
dysphagia, drooling, nasal regurg
tongue 
- wasting
- fasciculations
cant stick tongue out

palatal movement - absent
gag reflex - absent
jaw jerk - normal
emotions not affected

Question 5

clinical features of pseudobulbar palsy

Answer 5

absent facial expressions
speech - dysarthira - husky, nasal voice
difficulty in chewing

dysphagia, drooling, nasal regurg

tongue - spastic pointed
cant stick tongue out
no fasciculations or wasting

palatal movement - absent
gag reflex - exaggerated
jaw reflex exaggerated

emotional incontinence

Question 6

Tx for bulbar or pseudobalabr palsy

Answer 6

Anticholinergics to control drooling
Baclofen for spasticity of pseudobulbar palsy
Percutaneous endoscopic gastrostomy tube (PEG): for patients with severe dysphagia or recurrent aspiration pneumonia
Speech and language therapy
Tricyclic antidepressants, SSRIs, or a combination of dextromethorphan hydrobromide and quinidine sulfate (Nuedexta): for patients with pseudobulbar affect