Bulbar and pseudobulbar syndrome: what it is, photos, causes and treatment of the disorder. Bulbar Syndrome: symptoms, causes, treatment Bulbar syndrome treatment with folk remedies

Bulbar syndrome refers to a pathology of cranial nerves, when not a single nerve is affected, but a whole group: glossopharyngeal, vagus and hypoglossal, the nuclei of which are located in the medulla oblongata.

Symptoms and causes of bulbar syndrome

Bulbar syndrome (otherwise known as bulbar palsy) can be unilateral or bilateral. Swallowing disorders most often occur against the background of pathology. This leads to the fact that it becomes difficult or impossible (aphagia). Also, usually as a result of the syndrome, speech and voice articulation disorders occur - it acquires a nasal and hoarse tone.

Disorders of the autonomic system may also develop, usually manifesting themselves in the form of disturbances in cardiac activity and breathing.

The most common signs of bulbar syndrome are:

Lack of facial expressions, inability to chew, swallow, or close your mouth independently;
Entry of liquid food into the nasopharynx;
Hanging of the soft palate and deviation of the uvula in the direction opposite to the paralysis;
Absence of palatal and pharyngeal reflexes;
Slurred, nasal speech;
Phonation disorders;
Cardiovascular disorders;
Arrhythmia.

Doctors include various diseases as the main causes of bulbar syndrome:

Myopathy – oculopharyngeal, Kearns-Sayre syndrome. A feature of the hereditary disease oculopharyngeal myopathy, as one of the causes of bulbar syndrome, is its late onset (most often after 45 years), as well as muscle weakness, limited to the facial muscles and bulbar muscles. The main maladaptive syndrome is;
Motor neuron diseases – Fazio-Londe spinal amyotrophy, amyotrophic lateral sclerosis, Kennedy bulbospinal amyotrophy. At the onset of the disease, there is difficulty swallowing liquid food more often than solid food. However, as the disease progresses, along with tongue weakness, weakness of the facial and masticatory muscles develops, and the tongue in the oral cavity becomes atrophic and immobile. Weakness of the respiratory muscles and constant drooling occur;
Dystrophic myotonia, which most often affects men. The disease begins at 16-20 years of age. Bulbar syndrome leads to dysphagia, nasal tone of voice, choking, and in some cases – to respiratory disorders;
Paroxysmal myoplegia, manifested by partial or generalized attacks of muscle weakness, which can last from half an hour to several days. The development of the disease is provoked by increased consumption of table salt, plentiful food rich in carbohydrates, stress and negative emotions, and increased physical activity. The respiratory muscles are rarely involved;
Myasthenia gravis, the main clinical manifestation of which is excessive muscle fatigue. Its first symptoms are usually dysfunction of the extraocular muscles and muscles of the face and limbs. Often, bulbar syndrome affects the muscles of mastication, as well as the muscles of the larynx, pharynx and tongue;
Polyneuropathy, in which bulbar palsy is observed against the background of tetraplegia or tetraparesis with quite characteristic disorders that make it easier to diagnose and treat bulbar syndrome;
, which is recognized by general infectious symptoms, the rapid development of paralysis (usually in the first 5 days of illness) with significantly greater damage to the proximal parts than the distal ones;
Processes occurring in the posterior fossa, brain stem and craniospinal region, including tumors, vascular diseases, granulomatous diseases and bone abnormalities. Typically these processes involve the two halves of the medulla oblongata;
Psychogenic dysphonia and dysphagia, which can accompany both psychotic disorders and conversion disorders.

Pseudobulbar syndrome

Pseudobulbar syndrome usually occurs only against the background of bilateral damage to the corticonuclear pathways that go to the nuclei of the bulbar nerves from the motor cortical centers.

This pathology is manifested by central paralysis of swallowing, disturbances in phonation and speech articulation. Also, against the background of pseudobulbar syndrome, the following may occur:

Dysphonia.

Video: Bulbar syndrome

However, unlike bulbar syndrome, in these cases atrophy of the tongue muscles does not develop. The palatal and pharyngeal reflexes are also usually preserved.

Pseudobulbar syndrome, as a rule, is observed against the background of dyscirculatory disorders, acute cerebrovascular accidents in both hemispheres of the brain, and amyotrophic lateral sclerosis. It is considered less dangerous because it does not lead to disruption of vital functions.

Diagnosis and treatment of bulbar syndrome

After consulting a therapist, to diagnose bulbar syndrome it is usually necessary to undergo a series of studies:

General urine test;
EMG of the muscles of the tongue, limbs and neck;
General and biochemical blood test;
CT or MRI of the brain;
Esophagoscopy;
Examination by an ophthalmologist;
Clinical and EMG tests for myasthenia gravis with pharmacological load;
Study of cerebrospinal fluid;

Depending on the clinical symptoms and the nature of the pathology, the doctor can predict the outcome and effectiveness of the proposed treatment for bulbar syndrome. As a rule, therapy is aimed at eliminating the causes of the underlying disease. At the same time, measures are taken to support and resuscitate impaired important body functions, namely:

Video: Exercise therapy for bulbar syndrome

Breathing – artificial ventilation;
Swallowing – drug therapy with proserine, vitamins, ATP;
Drooling - prescription of atropine.

It is quite important against the background of pseudobulbar and bulbar syndrome to carry out careful care of the oral cavity, and also, if necessary, to monitor patients while eating to prevent aspiration.

Video: Maksimka HELP THE BABY GET A CHANCE TO LIFE!!

Everything interesting

Video: Chiari malformation type I: symptoms, treatment, surgery. Interview with neurosurgeon A.A. Reutov. Arnold-Chiari anomaly is a congenital pathology of the development of the rhombencephalon, in which there is a discrepancy in the size of the posterior cranial...

Video: Shocking results of treatment of muscular dystrophy, atrophy and myopathy! Muscle atrophy is a process that develops in the muscles and leads to a progressive decrease in volume, resulting in their degeneration. In other words,…

Video: Amyotrophic lateral sclerosis (ALS). Who is at risk of getting sick Amyotrophic lateral sclerosis is a degenerative disease of the nervous system associated with the death of peripheral and central motor neurons. Otherwise, the disease is called motor neuron…

Dysphagia is a swallowing disorder caused by functional or organic obstructions that prevent a bolus of food from moving naturally through the esophagus. The patient experiences discomfort because there is a constant feeling...

Dystonia is a syndrome characterized by constant or spasmodic muscle contraction, affecting both the agonist muscle and the muscle that counteracts it. Quite often, such spasms are unpredictable. The disease can become chronic...

Video: Test for the presence of dysarthria Part 1) Dysarthria is a pronunciation disorder associated with insufficient innervation of the speech apparatus caused by damage to the subcortical and posterior frontal parts of the brain. The disease is characterized by limited mobility...

Hypothalamic syndrome is a set of disorders provoked by pathologies of the hypothalamus of various origins. These may be dysfunctions of the endocrine system, autonomic disorders, disruptions in the flow of metabolic...

Klinefelter syndrome is a genetic disease characterized by the presence of at least one extra X chromosome in boys. This usually leads to disruption of puberty with subsequent infertility that cannot be treated. The first clinical case…

Video: Manic-depressive psychosis Manic syndrome is a pathological condition characterized by a combination of increased activity, which is usually accompanied by a good mood, and a lack of fatigue. In a manic state...

Muscle weakness or myasthenia gravis is a decrease in the contractility of one or more muscles. This symptom can be observed in any part of the body. Muscle weakness is more common in the legs and arms. The causes of muscle…

Restless legs syndrome (RLS) is commonly called one of the most common neurological diseases, characterized by unpleasant pain in the legs that force a person to make any forced movements...

Dysfunction of the cranial nerves, the nuclei of which are located in the medulla oblongata, is called bulbar syndrome. The main characteristic of the disease is general paralysis of the tongue, muscles of the pharynx, lips, epiglottis, vocal cords and soft palate. Often the consequence of bulbar syndrome (paralysis) is a disorder of the speech apparatus, the functions of swallowing, chewing and breathing.

A less pronounced degree of paralysis is manifested in cases of unilateral damage to the nuclei of the IX, X, XI and XII (caudal group) nerves, their trunks and roots in the medulla oblongata, but a severe degree of bulbar syndrome is more common with bilateral damage to the same nerves.

Pseudobulbar syndrome is a bilateral interruption of the corticonuclear pathways, leading to a neurological syndrome. It has a similar clinical picture to bulbar syndrome, but has a number of distinctive features and occurs due to damage to other parts and structures of the brain.

A significant difference between bulbar and pseudobulbar syndrome is that in the second there is no disturbance in the rhythm of cardiac activity, atrophy of paralyzed muscles, or cessation of breathing (apnea). It is often accompanied by unnatural forced laughter and crying of the patient, resulting from a disruption of the connection between the central subcortical nodes and the cerebral cortex. Most often, pseudobulbar syndrome occurs with diffuse brain lesions of traumatic, vascular, intoxication or infectious origin.

Bulbar syndrome: causes

The list of possible causes of paralysis is quite wide, it includes genetic, vascular, degenerative and infectious factors. Thus, genetic causes include acute intermittent porphyria and Kennedy bulbospinal amyotrophy, and degenerative causes include syringobulbia, Lyme disease, polio and Guillain-Barré syndrome. The cause of bulbar syndrome can also be a stroke of the medulla oblongata (ischemic), which is much more likely than other diseases to lead to death.

The development of bulbar syndrome occurs with amyotrophic lateral sclerosis, paroxysmal myoplegia, spinal amyotrophy Fazio-Londe, diphtheria, post-vaccination and paraneoplastic polyneuropathy, as well as due to hyperthyroidism.

Other probable causes of bulbar syndrome include diseases and processes in the posterior cranial fossa, brain and craniospinal region, such as:

Botulism;
Tumor in the medulla oblongata;
Bone abnormalities;
Syringobulbia;
Granulomatous diseases;
Meningitis;
Encephalitis.

Against the background of paroxysmal myoplegia, myasthenia gravis, dystrophic myotonia, oculopharyngeal myopathy, Kearns-Sayre syndrome, psychogenic dysphonia and dysphagia, paralysis can also develop.

Symptoms of bulbar syndrome

With paralysis, patients have problems with the consumption of liquid food, they often choke on it, and sometimes they cannot reproduce swallowing movements, which is why saliva may flow from the corners of their mouth.

In especially severe cases of bulbar syndrome, a disorder of cardiovascular activity and respiratory rhythm may occur, which is due to the close location of the nuclei of the cranial nerves of the caudal group with the centers of the respiratory and cardiovascular systems. Such involvement of the cardiac and respiratory systems in the pathological process often leads to death.

A sign of bulbar syndrome is loss of the palatal and pharyngeal reflexes, as well as atrophy of the tongue muscles. This occurs due to damage to the nuclei of the IX and X nerves, which are part of the reflex arcs of the above reflexes.

The most common symptoms of bulbar syndrome are the following:

The patient lacks facial expressions, he cannot swallow or chew food fully;
Violation of phonation;
Getting liquid food into the nasopharynx after consumption;
Heart dysfunction;
Nasal and slurred speech;
In the case of unilateral bulbar syndrome, there is a deviation of the tongue to the side not affected by paralysis, its twitching, as well as drooping of the soft palate;
Breathing disorders;
Absence of palatine and pharyngeal reflex;
Pulse arrhythmia.

Symptoms of paralysis in each individual case can be of varying degrees of severity and complexity.

Diagnosis of bulbar syndrome

Before proceeding with direct treatment, the doctor must examine the patient, especially the oropharynx area, identify all the symptoms of the disease, and conduct an electromyography, according to which it is possible to determine the severity of paralysis.

Treatment of bulbar syndrome

In some cases, to save the life of a patient with bulbar syndrome, preliminary emergency care is required. The main goal of such assistance is to eliminate the threat to the patient’s life before he is transported to a medical facility, where adequate treatment will then be selected and prescribed.

The doctor, depending on the clinical symptoms and the nature of the pathology, can predict the outcome of the disease, as well as the effectiveness of the proposed treatment for bulbar syndrome, which is carried out in several stages, namely:

Resuscitation, support of those body functions that were impaired due to paralysis - artificial ventilation to restore breathing, the use of Proserin, adenosine triphosphate and vitamins to trigger the swallowing reflex, the appointment of Atropine to reduce salivation;
This is followed by symptomatic therapy aimed at alleviating the patient’s condition;
Treatment of the disease against which the development of bulbar syndrome occurred.

Patients with paralysis are fed enterally, using a feeding tube.

Bulbar syndrome is a disease that occurs due to disruption of the cranial nerves. Often, even with adequate treatment, it is possible to achieve 100% recovery of the patient only in isolated cases, but it is quite possible to significantly improve the patient’s well-being.

Bulbar syndrome (or bulbar palsy) is a complex lesion of the IX, X and XII cranial nerves (vagus, glossopharyngeal and hypoglossal nerves), whose nuclei are located in the medulla oblongata. They innervate the muscles of the lips, soft palate, tongue, pharynx, larynx, as well as the vocal cords and epiglottic cartilage.

Symptoms

Bulbar palsy is a triad of three leading symptoms: dysphagia(swallowing disorder), dysarthria(violation of the correct pronunciation of articulate speech sounds) and aphonia(violation of speech sonority). A patient suffering from this paralysis cannot swallow solid food, and liquid food will enter the nose due to paresis of the soft palate. The patient’s speech will be incomprehensible with a hint of nasalism (nasalism), this disturbance is especially noticeable when the patient pronounces words containing such complex sounds as “l” and “r”.

To make a diagnosis, the doctor must conduct a study of the functions of the IX, X and XII pairs of cranial nerves. Diagnosis begins with finding out whether the patient has problems swallowing solid and liquid food, or whether he chokes on it. During the answer, the patient’s speech is carefully listened to, and the disturbances characteristic of paralysis noted above are noted. Then the doctor examines the oral cavity and performs laryngoscopy (a method of examining the larynx). With unilateral bulbar syndrome, the tip of the tongue will be directed towards the lesion, or completely motionless with bilateral one. The mucous membrane of the tongue will be thinned and folded - atrophic.

Examination of the soft palate will reveal its lag in pronunciation, as well as deviation of the uvula in the healthy direction. Using a special spatula, the doctor checks the palatine and pharyngeal reflexes, irritating the mucous membrane of the soft palate and the back wall of the pharynx. The absence of gagging and coughing movements indicates damage to the vagus and glossopharyngeal nerves. The study ends with laryngoscopy, which will help confirm paralysis of the true vocal cords.

The danger of bulbar syndrome lies in damage to the vagus nerve. Insufficient function of this nerve will cause abnormal heart rhythm and breathing problems, which can immediately lead to death.

Etiology

Depending on what disease causes bulbar palsy, there are two types: acute and progressive. Acute most often occurs due to acute circulatory disturbance in the medulla oblongata (infarction) due to thrombosis, vascular embolism, and also when the brain is wedged into the foramen magnum. Severe damage to the medulla oblongata leads to disruption of the vital functions of the body and subsequent death of the patient.

Progressive bulbar palsy develops in amyotrophic lateral sclerosis. This rare disease is a degenerative change in the central nervous system that causes damage to motor neurons, causing muscle atrophy and paralysis. ALS is characterized by all the symptoms of bulbar palsy: dysphagia when taking liquid and solid food, glossoplegia and tongue atrophy, sagging of the soft palate. Unfortunately, treatment for amyotrophic sclerosis has not been developed. Paralysis of the respiratory muscles causes the death of the patient due to the development of suffocation.

Bulbar palsy often accompanies a disease such as myasthenia gravis. It is not for nothing that the second name of the disease is asthenic bulbar palsy. The pathogenesis consists of an autoimmune lesion of the body, causing pathological muscle fatigue.

In addition to bulbar lesions, the symptoms include muscle fatigue after physical activity, which disappears after rest. Treatment of such patients consists of the doctor prescribing anticholinesterase drugs, most often Kalimin. Prescribing Proserin is not advisable due to its short-term effect and a large number of side effects.

Differential diagnosis

It is necessary to correctly differentiate bulbar syndrome from pseudobulbar palsy. Their manifestations are very similar, however, there is a significant difference. Pseudobulbar palsy is characterized by reflexes of oral automatism (proboscis reflex, distance-oral and palmar-plantar reflex), the occurrence of which is associated with damage to the pyramidal tracts.

The proboscis reflex is detected by carefully tapping the upper and lower lips with a neurological hammer - the patient pulls them out. The same reaction can be observed when the hammer approaches the lips - the distance-oral reflex. Streak irritation of the skin of the palm above the eminence of the thumb will be accompanied by contraction of the mentalis muscle, causing the skin to be pulled up on the chin - the palmomental reflex.

Treatment and prevention

First of all, treatment of bulbar syndrome is aimed at eliminating the cause that caused it. Symptomatic therapy consists of eliminating respiratory failure using a ventilator. To restore swallowing, a cholinesterase inhibitor is prescribed. It blocks cholyesterase, as a result of which the action of acetylcholine is enhanced, leading to the restoration of conduction along the neuromuscular fiber.

M-anticholinergic Atropine blocks M-cholinergic receptors, thereby eliminating increased salivation. Patients are fed through a tube. All other treatment measures will depend on the specific disease.

There is no specific prevention for this syndrome. To prevent the development of bulbar palsy, it is necessary to promptly treat diseases that can cause it.

Video about how exercise therapy is performed for bulbar syndrome:

Symptoms and causes of bulbar syndrome

Disorders of the autonomic system may also develop, usually manifesting themselves in the form of disturbances in cardiac activity and breathing.

The most common signs of bulbar syndrome are:

Lack of facial expressions, inability to chew, swallow, or close your mouth independently;
Entry of liquid food into the nasopharynx;
Hanging of the soft palate and deviation of the uvula in the direction opposite to the paralysis;
Absence of palatal and pharyngeal reflexes;
Slurred, nasal speech;
Phonation disorders;
Cardiovascular disorders;
Arrhythmia.

Doctors include various diseases as the main causes of bulbar syndrome:

Myopathy – oculopharyngeal, Kearns-Sayre syndrome. A feature of the hereditary disease oculopharyngeal myopathy, as one of the causes of bulbar syndrome, is its late onset (most often after 45 years), as well as muscle weakness, limited to the facial muscles and bulbar muscles. The main maladaptive syndrome is dysphagia;
Motor neuron diseases – Fazio-Londe spinal amyotrophy, amyotrophic lateral sclerosis, Kennedy bulbospinal amyotrophy. At the onset of the disease, there is difficulty swallowing liquid food more often than solid food. However, as the disease progresses, along with tongue weakness, weakness of the facial and masticatory muscles develops, and the tongue in the oral cavity becomes atrophic and immobile. Weakness of the respiratory muscles and constant drooling occur;
Dystrophic myotonia, which most often affects men. The disease begins at 16-20 years of age. Bulbar syndrome leads to dysphagia, nasal tone of voice, choking, and in some cases – to respiratory disorders;
Paroxysmal myoplegia, manifested by partial or generalized attacks of muscle weakness, which can last from half an hour to several days. The development of the disease is provoked by increased consumption of table salt, plentiful food rich in carbohydrates, stress and negative emotions, and increased physical activity. The respiratory muscles are rarely involved;
Myasthenia gravis, the main clinical manifestation of which is excessive muscle fatigue. Its first symptoms are usually dysfunction of the extraocular muscles and muscles of the face and limbs. Often, bulbar syndrome affects the muscles of mastication, as well as the muscles of the larynx, pharynx and tongue;
Polyneuropathy, in which bulbar palsy is observed against the background of tetraplegia or tetraparesis with quite characteristic disorders that make it easier to diagnose and treat bulbar syndrome;
Poliomyelitis, which is recognized by general infectious symptoms, rapid development of paralysis (usually in the first 5 days of illness) with significantly greater damage to the proximal parts than to the distal ones;
Processes occurring in the posterior fossa, brain stem and craniospinal region, including tumors, vascular diseases, granulomatous diseases and bone abnormalities. Typically these processes involve the two halves of the medulla oblongata;
Psychogenic dysphonia and dysphagia, which can accompany both psychotic disorders and conversion disorders.

Pseudobulbar syndrome

Pseudobulbar syndrome usually occurs only against the background of bilateral damage to the corticonuclear pathways that go to the nuclei of the bulbar nerves from the motor cortical centers.

This pathology is manifested by central paralysis of swallowing, disturbances in phonation and speech articulation. Also, against the background of pseudobulbar syndrome, the following may occur:

Dysphagia;
Dysarthria;
Dysphonia.

However, unlike bulbar syndrome, in these cases atrophy of the tongue muscles does not develop. The palatal and pharyngeal reflexes are also usually preserved.

Pseudobulbar syndrome is usually observed against the background of dyscirculatory encephalopathy, acute cerebrovascular accidents in both hemispheres of the brain, and amyotrophic lateral sclerosis. It is considered less dangerous because it does not lead to disruption of vital functions.

Diagnosis and treatment of bulbar syndrome

After consulting a therapist, to diagnose bulbar syndrome it is usually necessary to undergo a series of studies:

General urine test;
EMG of the muscles of the tongue, limbs and neck;
General and biochemical blood test;
CT or MRI of the brain;
Esophagoscopy;
Examination by an ophthalmologist;
Clinical and EMG tests for myasthenia gravis with pharmacological load;
Study of cerebrospinal fluid;

Breathing – artificial ventilation;
Swallowing – drug therapy with proserine, vitamins, ATP;
Drooling - prescription of atropine.

When some areas of the brain are damaged, serious pathological processes can appear that reduce a person’s standard of living, and in some cases, threaten death.

Bulbar and pseudobulbar syndrome are disorders of the central nervous system, the symptoms of which are similar to each other, but their etiology is different.

Bulbar occurs due to damage to the medulla oblongata - the nuclei of the glossopharyngeal, vagus and hypoglossal nerves that are located in it.

Pseudobulbar syndrome (paralysis) manifests itself due to disruption of the conductivity of the corticonuclear pathways.

Clinical picture of bulbar syndrome

The main diseases during or after which bulbar palsy occurs:

stroke affecting the medulla oblongata;
infections (tick-borne borreliosis, acute polyradiculoneuritis);
trunk glioma;
botulism;
displacement of brain structures with damage to the medulla oblongata;
genetic disorders (porphyrin disease, bulbospinal amyotrophy Kennedy);
Syringomyelia.

Porphyria is a genetic disorder that often causes bulbar palsy. The unofficial name - vampire disease - is given because of a person’s fear of the sun and the effect of light on the skin, which begins to burst, become covered with ulcers and scars. Due to the involvement of cartilage in the inflammatory process and deformation of the nose, ears, as well as exposure of teeth, the patient becomes like a vampire. There is no specific treatment for this pathology.

Isolated bulbar palsies are uncommon due to the involvement of the nuclei of nearby structures of the medulla oblongata during damage.

The main symptoms that occur in the patient:

speech disorders (dysarthria);
swallowing disorders (dysphagia);
voice changes (dysphonia).

Patients speak with difficulty and slur, their voice becomes weak, to the point that it becomes impossible to make a sound. The patient begins to pronounce sounds through the nose, his speech is blurred and slow. Vowel sounds become indistinguishable from each other. Not only paresis of the tongue muscles, but their complete paralysis may occur.

Patients choke on food and often cannot swallow it. Liquid food enters the nose, and aphagia may occur (complete inability to swallow).

The neurologist diagnoses the disappearance of the soft palate and pharyngeal reflexes and notes the appearance of twitching of individual muscle fibers and muscle degeneration.

In case of severe damage, when the cardiovascular and respiratory centers are involved in the medulla oblongata, disturbances in the rhythm of breathing and heart activity occur, which can be fatal.

Manifestations and causes of pseudobulbar syndrome

Diseases after or during which pseudobulbar palsy develops:

vascular disorders affecting both hemispheres (vasculitis, atherosclerosis, hypertensive lacunar cerebral infarctions);
traumatic brain injuries;
brain damage due to severe hypoxia;
epileptoform syndrome in children (a single episode of paralysis may occur);
demyelinating disorders;
Pick's disease;
bilateral perisylvian syndrome;
multiple system atrophy;
intrauterine pathology or birth trauma in newborns;
genetic disorders (amyotrophic lateral sclerosis, olivopontocerebellar degenerations, Creutzfeldt-Jakob disease, familial spastic paraplegia, etc.);
Parkinson's disease;
glioma;
neurological conditions after inflammation of the brain and its membranes.

Creutzfeldt-Jakob disease, in which not only pseudobulbar syndrome is observed, but also symptoms of rapidly progressing dementia, is a serious disease, the predisposition to which is genetically determined. It develops due to the entry into the body of abnormal tertiary proteins, similar in their action to viruses. In most cases, death occurs within a year or two from the onset of the disease. There is no treatment that eliminates the cause.

The symptoms that accompany pseudobulbar palsy, like bulbar palsy, are expressed in dysphonia, dysphagia and dysarthria (in a milder version). But these two lesions of the nervous system have differences.

If with bulbar palsy atrophy and degeneration of muscles occurs, then these phenomena are absent with pseudobulbar palsy. Defibrillar reflexes also do not occur.

Pseudobulbar syndrome is characterized by uniform paresis of the facial muscles, which are spastic in nature: disorders of differentiated and voluntary movements are observed.

Since disturbances in pseudobulbar palsy occur above the medulla oblongata, there is no threat to life due to arrest of the respiratory or cardiovascular systems.

The main symptoms that indicate that pseudobulbar palsy has developed, and not bulbar, are expressed in violent crying or laughter, as well as reflexes of oral automatism, which are normally characteristic of children, and in adults indicate the development of pathology. This could be, for example, a proboscis reflex, when the patient stretches out his lips with a tube if light tapping is done near the mouth. The same action is performed by the patient if he brings any object to his lips. Contractions of the facial muscles can be caused by tapping the bridge of the nose or pressing the palm under the thumb.

Pseudobulbar palsy leads to multiple softened foci of the brain substance, so the patient experiences a decrease in motor activity, disorders and weakening of memory and attention, a decrease in intelligence and the development of dementia.

Patients may develop hemiparesis, a condition in which the muscles on one side of the body become paralyzed. Paresis of all limbs may occur.

With severe brain damage, pseudobulbar palsy can appear together with bulbar palsy.

Therapeutic effects

Since pseudobulbar syndrome and bulbar syndrome are secondary diseases, treatment should be aimed at the causes of the underlying disease, if possible. When the symptoms of the primary disease weaken, the signs of paralysis may smooth out.

The main goal of treatment for severe forms of bulbar palsy is to maintain the vital functions of the body. For this purpose they prescribe:

artificial ventilation;
tube feeding;
prozerin (it is used to restore the swallowing reflex);
atropine for excessive salivation.

After resuscitation measures, comprehensive treatment should be prescribed, which can affect primary and secondary diseases. Thanks to this, life is preserved and its quality is improved, and the patient’s condition is alleviated.

The issue of treating bulbar and pseudobulbar syndromes through the introduction of stem cells remains controversial: supporters believe that these cells can produce the effect of physical replacement of myelin and restore the functions of neurons, opponents point out that the effectiveness of using stem cells has not been proven and, on the contrary, increases the risk of developing cancerous tumors.

Restoration of reflexes in a newborn begins in the first 2 to 3 weeks of life. In addition to drug treatment, he undergoes massage and physiotherapy, which should have a tonic effect. Doctors give an uncertain prognosis, since complete recovery does not occur even with adequately chosen treatment, and the underlying disease may progress.

Bulbar and pseudobulbar syndrome are severe secondary lesions of the nervous system. Their treatment must be comprehensive and must be aimed at the underlying disease. In severe cases of bulbar palsy, respiratory and cardiac arrest may occur. The prognosis is unclear and depends on the course of the underlying disease.