Pseudobulbar palsy

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There are two principal types of bulbar palsy: progressive bulbar palsy (PBP) and pseudobulbar palsy. In both, the outstanding symptoms are dysphagia and dysarthria. PBP is a form of motor neuron disease involving bulbar innervated muscles. Pseudobulbar palsy is caused by bilateral supranuclear lesions involving the corticobulbar pathways.

In pseudobulbar palsy, the dysarthria is generally more spastic in nature. There may be dysphagia, nasal regurgitation, choking, and drooling. Patients may keep food in the mouth for prolonged periods. Although the tongue may be strikingly immobile, atrophy and fasciculations do not develop. There is often an exaggerated jaw jerk, a hyperactive gag reflex and frontal release signs such as snout and suck reflexes. Pseudobulbar affect is common.(1)

The video by Dr. Paul D. Larsen from the University of Utah collection demonstrates severe dysarthria, slow tongue movements and a hyperactive gag reflex.(2)

The most common cause is multiple cerebral infarctions. The syndrome may also occur in encephalitis, MS, trauma, cerebral anoxia, primary lateral sclerosis, or other disease processes that cause bilateral corticobulbar tract lesions.(3-5)

References

1. Gillespie DC, Cadden AP, Lees R, et al. Prevalence of Pseudobulbar Affect following Stroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis. 2016 Mar;25(3):688-94.

2. Movies drawn from the NeuroLogic Exam and PediNeuroLogic Exam websites are used by permission of Paul D. Larsen, M.D., University of Nebraska Medical Center and Suzanne S. Stensaas, Ph.D., University of Utah School of Medicine. Additional materials were drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin. The movies are licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 2.5 License.

3. Becker A, Hardmeier M, Steck AJ, et al. Primary lateral sclerosis presenting with isolated progressive pseudobulbar syndrome. Eur J Neurol 2007;14:e3.

4. Jang SH, Lee J, Seo JP. Pseudobulbar palsy due to bilateral injuries of corticobulbar tracts in a stroke patient. Int J Stroke. 2015 Aug;10(6):E53-4.

5. Loeb C, Gandolfo C, Caponnetto C, et al. Pseudobulbar palsy: a clinical computed tomography study. Eur Neurol. 1990;30(1):42-6.