Pseudobulbar palsy

Introduction Pseudobulbaric palsy refers to cerebral vascular disease that does not involve the medullary swallowing center, but stroke causes bilateral medullary bundles to be damaged, causing the nucleus that governs the movement of the throat muscles and the sublingual motor nucleus dysfunction that governs the tongue muscle. Difficulty in swallowing and pronunciation. Aspiration refers to food that feeds into the mouth, throat, or reflux. The contents of the stomach cannot be swallowed or spit out in time and enter the trachea, irritating the respiratory tract, causing cough, wheezing, or even suffocation. According to statistics, the incidence of aspiration in swallowing difficulties in stroke can reach 22.22%.

Cause

Related factors of aspiration

1. Cognitive-deficient patients lack scientific judgment on the timing of eating, the amount of eating, and the traits. They blindly think that they can eat themselves better than nasal feeding. If they eat slightly, they will reject nasal feeding. The amount of eating is unscientific, and the less they are, the less likely they are. Cough, the thinner the food, the easier it is to swallow. Even the family will give the patient water to drink. They think that water is easier to swallow than food. Many patients try to eat without scientific evaluation. The pharyngeal reflex exists in patients with pseudobulbaric paralysis, and there is no loss of pharyngeal sensation. Due to the presence of swallowing reflexes, the food is pushed into the pharyngeal cavity and can be swallowed by swallowing to swallow the food. If the soft palate and the pharyngeal muscle paralysis are heavier, the liquid diet is prone to ruminating due to food reversing into the nasal cavity or into the throat. A small number of stroke patients are asymptomatically inhaled food or liquid, and patients and their families do not recognize dysphagia and have no knowledge of pseudobulbaric palsy.

2. Hazard signs do not pay attention to dysphonia, dysarthria, active cough abnormalities, abnormal changes in swallowing, such as salivation, oral leaks, cheek pouch formation, frequent clearing, shortness of breath during eating or immediately after eating. And the texture or viscosity of the food or liquid, temperature, taste, so that the patient can make a modern position or evasive action, etc., which can be used as a feature of aspiration risk. Families and even medical staff rarely pay attention to these factors related to dysphagia.

3. Other factors Age factors, vomiting or gastric reflux, cardiopulmonary dysfunction, are risk factors for aspiration. Older patients over the age of 70, due to decreased sense of the throat, poor coordination, reduced swallowing reflexes, reduced the reflective action to prevent foreign matter from entering the airway, prone to aspiration. Patients with high intracranial pressure, brain stem, cerebellar lesions or vertebrobasilar insufficiency of blood supply, prone to vomiting, and large amount of vomiting, faster and more likely to cough, so patients with this lesion of bulbar paralysis should pay attention to aspiration. Swallowing is voluntary exercise, and breathing needs to be temporarily stopped when swallowing. For patients with pseudobulbaric palsy with cardiopulmonary dysfunction, the breathing rhythm is irregular, wheezing, coughing, and phlegm increase the chance of aspiration.

an examination

Related inspection

Transcranial ultrasound examination of transesophageal echocardiography (TEE)

I don't know the order of eating, repeat the same action, and the risk of swallowing is increased when eating. It is easy to ignore the food on the side of the table. The tongue and masseter muscles are normal but cannot swallow the food stuffed in the mouth.

Differential diagnosis

Myogenic medulla obliterata: more common in myasthenia gravis, dermatomyositis, polymyositis and other diseases, no sensory disturbances and fascia muscle twitching, muscle biopsy can help diagnose.

prompt:

1. Use bamboo sticks to stimulate the palmar muscles or small fish muscles of one palm to appear contraction of the diaphragm.

2. The patient's head is slightly flexed, and the head of the upper lip is slammed with a percussion hammer.

3. The cornea was stimulated by one side of the cornea while the bilateral closed eyes and the mandibular to the contralateral side were called the mandibular reflex.

According to IX, X, XI, XII, dysphagia caused by pharyngeal muscle paralysis dominated by cranial nerves, and dysarthria can be diagnosed as bulbar palsy. Further, it is necessary to determine the lesions leading to medullary paralysis, including the bilateral cortical medullary tract in the cerebral cortex motor area and the IXXXI, XII on the cranial nerve or its inner muscle. Medullary palsy needs to be differentiated from apraxia.

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