Pseudobulbar Palsy degeneration of corticobulbar pathways to V,VII,X,XI,XII

Bulbar Palsy disturbance to X, XI, XII,sometimes VII, rather than the corticobulbar tracts

lower motor neurone lower motor neurone signs absent signs present gag reflex (+/n) spastic tongue jaw jerk (+) spastic dysarthria labile emotions bilateral UMN gag reflex (-) wasted tongue, fasciculations jaw jerk (n) nasal speech normal emotions signs in limbs

+ = increased; - = reduced; n = normal There is a lot of difference between bulbar and pseudobulbar palsy. Let me list them hereunder. 1. Pseudobulbar palsy is an upper motor neuron type of lesion affecting the corticobulbar fibres, that is, fibres connecting cerebral cortex to cranial nerve nuclei in the bulb aka medulla. So in such a lesion features are mainly of the UMN type. Jaw jerk is exaggerated, gag reflex is present, tongue is spastic with a pointed tip. There is emotional lability and patient often has uncontrollable bouts of laughter and crying. Other features are just like bulbar palsy, e.g., dysphagia, dysarthria, nasal intonation of voice, nasal regurgitation while drinking liquids etc. 2. Coming to bulbar palsy, bulb means medulla. Any lesion affecting cranial nerve nuclei in the bulb or medulla leads to bulbar palsy. Symptoms are just like in the pseudobulbar case: dysphagia, dysarthria, nasal intonation, nasal regurgitation. Salient differences are jaw jerk absent, gag reflex absent, tongue is flaccid with a rounded tip sometimes showing fasciculations. No emotional lability..basically it is a LMN type of lesion.. Thank you for the question. Hope this helps. References: Richard S Snell's text book of Neuroanatomy Bedside Clinics In Medicine, Arup Kumar Kundu (Academic Publishers )

Bulbar And Pseudobulbar Palsy

Overview

A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII. A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII.

Causes
Bulbar palsy

Motor neurone disease Syringobulbia Guillain-Barre syndrome Poliomyelitis Subacute menignitis (carcinoma, lymphoma) Neurosyphilis Brainstem CVA Pseudobulbar palsy The commonest cause is bilateral CVAs affecting the internal capsule. Other causes include:

Multiple sclerosis Motor neurone disease High brainstem tumours Head injury

Features
Bulbar palsy The clinical features include:

Gag reflex absent Tongue wasted, fasciculations wasted, wrinkled, thrown into folds and increasingly motionless. Palatal movement absent. Jaw jerk absent or normal Speech nasal indistinct (flaccid dysarthria), lacks modulation and has a nasal twang Emotions normal Other signs of the underlying cause, e.g. limb fasciculations. Pseudobulbar palsy The clinical features include:

Gag reflex increased or normal

Tongue spastic it cannot be protruded, lies on the floor of the mouth and is small and tight. Palatal movement absent. Jaw jerk increased Speech spastic: a monotonous, slurred, high-pitched, Donald Duck dysarthria that sounds as if the patient is trying to squeeze out words from tight lips. Emotions labile Other bilateral upper motor neuron (long tract) limb signs.

References And Links

Lifeinthefastlane.com

Neurological Mind Boggler 005 Pseudobulbar and Bulbar Palsies Journal Articles and Textbooks

Talley NJ, OConnor S. Clinical Examination: A Systematic Guide to Physical Diagnosis. MacLennan and Petty. 3rd edition, 1998.

Pseudobulbar And Bulbar Palsies

December 17, 2009 by Chris Nickson 2 Comments

aka Neurological Mind-boggler 005 You have an emotionally labile patient in the department who sounds like Donald duck. Before rounding up some students to pimp you decide to test yourself on bulbar and pseudobulbar palsies so that you dont get caught out Q1. What neurological lesions are involved in bulbar and pseudobulbar palsies? Show Answer A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII. A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII. Q2. What are the clinical features of a bulbar palsy? Show Answer The clinical features include:

Gag reflex absent Tongue wasted, fasciculations wasted, wrinkled, thrown into folds and increasingly motionless. Palatal movement absent.

Jaw jerk absent or normal Speech nasal indistinct (flaccid dysarthria), lacks modulation and has a nasal twang Emotions normal Other signs of the underlying cause, e.g. limb fasciculations. Q3. What are the clinical features of a pseudobulbar palsy? Show Answer The clinical features include:

Gag reflex increased or normal Tongue spastic it cannot be protruded, lies on the floor of the mouth and is small and tight. Palatal movement absent. Jaw jerk increased Speech spastic: a monotonous, slurred, high-pitched, Donald Duck dysarthria that sounds as if the patient is trying to squeeze out words from tight lips. Emotions labile Other bilateral upper motor neuron (long tract) limb signs. Q4. What are the causes of a bulbar palsy? Show Answer Causes include:

Motor neurone disease Syringobulbia Guillain-Barre syndrome Poliomyelitis Subacute menignitis (carcinoma, lymphoma) Neurosyphilis Brainstem CVA Q5. What are the causes of a pseudobulbar palsy? Show Answer The commonest cause is bilateral CVAs affecting the internal capsule. Other causes include:

Multiple sclerosis Motor neurone disease

High brainstem tumours Head injury Check out the Brainstem Rules of 4 for a (relatively) simple and useful way to understand the brainstem clinically.

References

Ryder RE, Mir MA, Freeman EA. An Aid to the MRCP Short Cases. Blackwell. 2nd edition, 1999. Talley NJ, OConnor S. Clinical Examination: A Systematic Guide to Physical Diagnosis. MacLennan and Petty. 3rd edition, 1998.
Dari note :

Peudo bulbar lesi di atas MO : UMN lesion diayts inti, tapi klinis mirip bulbar