Bulbar Palsy is a motor neuron lesion affecting the lower cranial nerves (9, 10, 11, 12). These nerves control movement of muscles responsible for chewing, swallowing, as well as movement of the head and neck. A speech deficit occurs as a result of facial paralysis or weakness of the muscles of articulation which are supplied by these cranial nerves. As the muscles of articulation are affected by bulbar palsy, symptoms will present accordingly, such as:
- Lip trembling
- Drooling – inability to swallow, saliva gathers in mouth
- Dysphonia – vocal cord paralysis results in rasping voice
- Difficulty in articulating
- Weak jaw, facial muscles
- Pharyngeal muscle weakness
Bulbar Palsy is sometimes confused with pseudobulbar palsy, and shares many of the same symptoms, with the exception that pseudobulbar palsy is caused by damage to the upper motor neurons.
A patient’s history, blood tests, and other testing including MRI and CT scan will assist in determining the underlying cause of Bulbar Palsy.
Bulbar Palsy can be caused by any of the following conditions:
- Cerebrovascular – medullary infarction
- Motor neuron disease
- High brain stem tumors
- Head injury
- Toxin – Botulism
- Inflammatory – Guillain-Barré syndrome, Lyme disease
- Subacute meningitis (carcinoma, lymphoma)
Bulbar Palsy Treatment
As there is no cure for Bulbar Palsy, treatment is essentially limited to medical management and support. For patients presenting with Bulbar Palsy, treatment will be directed to the underlying cause of the syndrome. Medication may include intravenous immunoglobulin (antibody) and steroids. Physical therapy can help to improve posture, slow muscle atrophy, and aid joint mobility. Spasticity can be reduced via strength and stretching exercises. Speech therapy, and additional therapy to assist with difficulties in chewing and swallowing are essential for management as well. A balanced diet and proper nutrition will be needed to maintain body weight and strength.
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