Bulbar palsy

Introduction Ball paralysis is the medullary palsy, because the medulla is also called the medullary ball, so the medullary palsy is called ball paralysis, also known as true ball paralysis. A group of symptoms occurs when the motor nuclei in the medulla, or the cranial nerves (including the glossopharyngeal, vagus, and hypoglossal nerves) from the medulla, cause paralysis due to illness. Mainly manifested in drinking water, eating cough, difficulty swallowing, hoarseness or loss of sound. Therefore, any lesion that directly damages the medulla oblongata or related cranial nerves is called true ball paralysis. The lesion is in the cerebral pons or the cerebral cerebral palsy, causing the inner nucleus of the cerebral ventricle to lose its upper innervation, and the medullary paralysis, which is called pseudobulbar paralysis.

Cause

(1) Causes of the disease

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

Medullary palsy can be all paralysis of the cranial nerves of IX, X, XI, and XII, or it can be 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, and XI are dominated by bilateral cortical brain stem bundles, and one side of the cortical brain stem bundle damage can be asymptomatic, and bilateral lesions are pseudobulbar paralysis. The cranial nerve XII is innervated by the contralateral unilateral cortical brainstem bundle. One side of the supra-nuclear, nuclear, and subnuclear lesions may have one side of supra-nuclear or sub-lingual sublingual nerve palsy. .

an examination

Related inspection

Brain CT examination cerebrospinal fluid pathogen examination cranial nerve examination

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

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

(2) Difficulties in vocalization: mainly due to the loss of motor function of bilateral vagus nerves, motor vocal cords, and paralysis of the muscles inside and outside the glottis. The initial vocal cords were weak, the pronunciation was low and rough, and the late sound loss and severe inspiratory difficulty and wheezing. If there is a voice loss and normal breathing function, 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 complicated signs of difficulty in eating, such as difficulty in swallowing, coughing of water, disappearance of pharyngeal reflexes, and weakness of chewing.

2. Check

(1) Neurological examination.

(2) MRI examination may be performed if necessary to further clarify the cause for differential diagnosis and assistance in diagnosis and treatment.

Differential diagnosis

Congestive symptoms of medullary paralysis

Pseudobulbaric palsy: refers to cerebrovascular disease that does not involve the medullary swallowing center, but the 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 muscles. , swallowing, difficulty in 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.

Cranial nerve palsy: common facial nerve injury, but also can have three nerves, glossopharyngeal nerve, vagus nerve injury. The principle of cerebral nerve palsy caused by aneurysm may be due to acute expansion of saccular aneurysm, direct compression or traction of the nerve; or aneurysmal hemorrhage, causing nerves to move; or edema due to venous congestion; or arachnoid adhesion due to bleeding Wait. If the aneurysm does not continue to expand, and thrombosis occurs, the symptoms of the eye tendon can be alleviated. Oculomotor palsy caused by aneurysms is almost accompanied by dilated and fixed pupils (90% to 96.8%), and pain or headache (92%) in the affected side. The drooping of the affected eyelid is also more common (about 60%).

Cranial nerve palsy: due to basal meningitis and other lesions involving the cranial nerve III, IV, V, VI, VII on the cranial nerve, thus causing the corresponding nerve palsy. There are symptoms such as decreased vision, double vision, drooping eyelids, oblique eyeball position, facial numbness, mouth slanting, mouth drooling, hearing loss, difficulty swallowing, drinking water, cough, abnormal pronunciation.

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