Bulbar palsy

Introduction to bulbar palsy The dysphagia and dysarthria caused by IX, X, XI, and XII on the cranial nerves and their associated muscle paralysis are called bulbar palsy. Medullary palsy, bulbar palsy, nucleus and subnuclear (true bulbar palsy, referred to as medullary palsy), nuclear (false medullary paralysis), the common clinical features of the two are "three difficulties": speech difficulties, Difficulty in pronunciation and difficulty swallowing. basic knowledge The proportion of sickness: 0.00235% Susceptible people: no special people Mode of infection: non-infectious Complications: aspiration pneumonia malnutrition

Cause of bulbar palsy

(1) Causes of the disease

The IX, X, XI, and XII emitted by the medulla oblongata is called the posterior group of cranial nerves. Its main function is to control the movement of the tongue and throat, which can lead to speech and dysphagia.

Medullary palsy can be either IX, X, XI, XII for all paralysis of the cranial nerves, but also partial nerve paralysis or individual nerve paralysis. The lesions include lower motor neurons, upper motor neurons and muscles.

The cause of medullary paralysis may be vascular diseases, inflammation, tumors, degenerative diseases, and autoimmune diseases.

(two) pathogenesis

Cerebral nerves IX, X, XI are dominated by bilateral cortical brain stem bundles, one side cortical brain stem bundle damage can be asymptomatic, bilateral lesions appear pseudobulbar paralysis, and cranial nerve XII is dominated by contralateral unilateral cortical brain stem bundle One side of the nucleus, nuclear, nuclear underlying damage can occur on one side of the nucleus or sublingual sublingual nerve palsy, bilateral damage to the tongue can not move.

Medullary palsy prevention

Pay attention to living habits and find early treatment early.

Medullary palsy complications Complications, aspiration pneumonia, malnutrition

Most patients suffer from malnutrition due to dysphagia and are extremely thin. They often die from asphyxia or aspiration pneumonia.

Medullary paralysis symptoms common symptoms pyramidal beam lesions sensory impairment inspiratory difficulties, weakness, cough and dysphagia

1. The medullary paralysis is mainly characterized by difficulty in speech, dysphonia, and difficulty in eating.

(1) Difficulties in speech: The earliest symptoms of medullary paralysis are often dysarthria. The patient is prone to fatigue, especially when it is necessary to improve the sound and aggravate the tone. Later, as the disease progresses, tongue, lips, soft palate and throat gradually appear. The paralysis of the structure of the structure.

(2) Difficulties in vocalization: mainly due to the loss of motor function of bilateral vagus nerves, sports vocal cords, muscle paralysis caused by intra- and extra-throat control of glottic fissure, initial vocal cord weakness, low pronunciation and rough, late loss of sound and severe inspiratory difficulty Wheezing, if there is a loss of sound and normal breathing, it is mostly hysteria.

(3) Difficulties in eating: In patients with bulbar palsy, due to paralysis of the lingual muscles, soft palate, and pharyngeal muscles, there are successive signs of difficulty in swallowing, drinking water, coughing, pharyngeal reflexes, and chewing weakness.

2. Each clinical type is described as follows

(1) true bulbar palsy: nuclear and subnuclear lesions.

1 acute onset:

A. Stroke: Brain CT shows cerebral bridge and medullary hemorrhage or damage.

B. Acute poliomyelitis (brain brain type): epidemiological history, fever, CSF protein-leukocyte separation, lower extremity dysfunction of the extremities.

C. Acute rhinitis: peripheral paralysis of the extremities, obvious root pain, often accompanied by bilateral paralysis, CSF protein-cell separation.

D. Diphtheria: Children under 5 years of age have a white pseudomembrane in the throat.

2 subacute chronic onset:

A. Amyotrophic lateral sclerosis (motor neuron disease): upper and lower limbs, muscle atrophy, no sensory disturbance.

B. Medullary cavity: separation of facial sensation.

C. Multiple sclerosis: with cranial nerves V, VII, VIII multifocal cranial nerve damage, remission and recurrence alternation.

D. Brain stem tumors: Progressive disease course, high intracranial pressure in the late stage, often accompanied by other cranial nerve damage, cerebellar signs or long beam signs.

E. Myasthenia gravis: Symptoms fluctuate and anti-cholinesterase (neosmide) is effective.

(2) pseudobulbar paralysis: arteriosclerosis, cerebrovascular disease (void infarction, multi-infarction or hemorrhage), multiple sclerosis, infection, poisoning, hypoxia, metabolic encephalopathy, tumor, trauma, encephalitis, cerebrospinal membrane Inflammation, etc., may lead to nuclear lesions of the posterior group of cranial nerves, which can be divided into three clinical types:

1 cortex, subcortical type (symptoms, mental retardation, mandatory urinary incontinence).

2 internal capsule type (with muscle rigidity, reduced movement, tremor and other tremor paralysis syndrome, bilateral pyramidal tract sign).

3 pons - cerebellar type (ataxia, walking disorders and cerebral nerve V, VII paralysis and other pons damage).

Examination of bulbar palsy

Select the necessary selective tests based on the likely cause: blood routine, blood electrolytes, blood sugar, immune items, cerebrospinal fluid examination, if abnormal, there is a differential diagnosis.

1. CT, MRI examination.

2. Skull base film.

3. EEG, fundus examination.

4. Otolaryngology examination.

Diagnosis and differentiation of bulbar palsy

diagnosis

Diagnosis based on clinical manifestations and laboratory tests.

Differential diagnosis

True and false medullary paralysis.

1. Use bamboo sticks to stimulate the palmar muscles or small fish muscles of one palm, and the diaphragm contraction is called palmar reflex.

2. The patient's head is slightly flexed, and the hammer is slammed into the middle of the upper lip, and the head is swift and then the head is reflected.

3. Stimulate one side of the limbus with cotton, and both eyes closed and the mandibular to the opposite side was called the mandibular reflex.

According to IX, X, XI, XII, the pharyngeal muscle paralysis caused by the cranial nerve, caused by dysphagia and dysarthria, can be diagnosed as medullary paralysis, and further need to determine the lesions leading to medullary paralysis, including the cerebral cortex In the exercise area, the bilateral cortical medullary bundles, and the IX, X, XI, and XII on the cranial nerves or the muscles they control, the medullary paralysis needs to be differentiated from apraxia.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.