When certain areas of the brain are damaged, serious pathological processes, reducing a person’s standard of living, and in some cases, threatening death.

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

Bulbar occurs due to damage 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 – genetic disorder, in which bulbar palsy often appears. Unofficial name– vampire disease – given due to 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 involvement in inflammatory process cartilage and deformation of the nose, ears, as well as exposure of teeth, the patient becomes like a vampire. Specific treatment this pathology is absent.

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 have difficulty speaking indistinctly, 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 gets into the nose, aphagia may occur ( complete absence ability to make swallowing movements).

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

At severe defeat, when the medulla oblongata involves cardiovascular and respiratory centers, disturbances in the rhythm of breathing and heart activity occur, which can lead to death.

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, - serious illness, 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 to eliminate 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 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 thumb hands.

Pseudobulbar palsy leads to multiple softened foci of the brain substance, so the patient experiences a decrease motor activity, disorders and weakening of memory and attention, decreased 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 symptoms subside primary disease, signs of paralysis may be smoothed out.

The main goal of treatment is severe forms bulbar palsy, is the maintenance of vital important functions 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, it should be prescribed complex treatment, 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. Besides drug treatment he undergoes massage and physiotherapy, which should have a tonic effect. Doctors give an uncertain prognosis because full recovery even with adequately selected treatment does not occur, 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.

The clinical manifestations of Pseudobulbar palsy were first described by Magnus in 1837, and in 1877 R. Lepine gave the name to this syndrome. In 1886, G. Oppenheim and E. Siemerling showed that Pseudobulbar palsy is observed with severe atherosclerosis cerebral vessels with the formation of multiple cysts in both hemispheres of the brain. In this case, the cortical-nuclear pathways (see full body of knowledge: Pyramid system) are affected on both sides at different levels, most often in the internal capsule, pons, and also in the cerebral cortex.

Pseudobulbar palsy is often observed with repeated ischemic disorders of cerebral circulation in both hemispheres. But it is also possible to develop the so-called single-stroke Pseudobulbar palsy, in which cerebral blood flow apparently decreases or a hidden regional deficiency in the other hemisphere of the brain is decompensated (see full body of knowledge: Stroke).

Pseudobulbar palsy is observed with diffuse vascular processes in the brain (for example, syphilitic endarteritis, rheumatic vasculitis, systemic lupus erythematosus), as well as with perinatal brain damage, hereditary changes in the corticonuclear tracts, Pick's disease (see full body of knowledge: Pick's disease) , Creutzfeldt-Jakob disease (see full body of knowledge: Creutzfeldt-Jakob disease), post-resuscitation complications (see full body of knowledge: Resuscitation) in persons who have suffered cerebral hypoxia (see full body of knowledge: Hypoxia). IN acute period cerebral hypoxia Pseudobulbar palsy can be observed as a consequence of diffuse damage to the cerebral cortex.

It is more often observed in people over 50 years of age who suffer from cerebrovascular pathology.

Clinical, picture Pseudobulbar palsy is characterized by a swallowing disorder - dysphagia (see full body of knowledge), a disorder of chewing, articulation - dysarthria or anarthria (see full body of knowledge: Dysarthria.). Paralysis of the muscles of the lips, tongue, soft palate, muscles involved in the act of swallowing, chewing, phonation, are not atrophic in nature and are significantly less pronounced than with bulbar palsy (see full body of knowledge). Reflexes of oral automatism are evoked (see full body of knowledge: Pathological reflexes). Patients are forced to eat extremely slowly due to weakness masticatory muscles, choking when swallowing; liquid food pours out through the nose while eating; salivation is observed. The reflex from the soft palate is usually increased, in some cases it is not evoked or is sharply reduced even with preserved motor function of the palatine muscles; the mandibular reflex is increased; paresis of the tongue muscles is often observed, and patients cannot hold their tongue out of their mouth for a long time.

Articulatory disorders in pseudobulbar palsy manifest themselves differently depending on the damage to individual or all muscle groups of the larynx, vocal cords, pharynx, as well as respiratory muscles.

Due to bilateral paresis of the facial muscles, hypomimia is observed with limited voluntary wrinkling of the forehead, squinting of the eyes, and baring of the teeth. Often Pseudobulbar palsy is accompanied by attacks of violent crying (less often laughter) due to spastic contraction facial muscles in a grimace of suffering without tearing and adequate emotions.

Sometimes disturbances of voluntary movements are detected eyeballs while maintaining their reflex movements, increasing deep reflexes from the masticatory muscles, which are in a spastic state. Pseudobulbar palsy can be combined with hemiparesis or tetraparesis (see full body of knowledge: Paralysis, paresis) varying degrees severity, urinary disorders in the form of urgency or urinary incontinence.

Pseudobulbar palsy (synonymous with false bulbar palsy) is clinical syndrome, characterized by disorders of chewing, swallowing, speech, and facial expressions. It occurs during a break central paths, coming from the motor centers of the cortex cerebral hemispheres brain to the motor nuclei of the medulla oblongata, in contrast to boulevard paralysis (see), in which the nuclei themselves or their roots are affected. Pseudobulbar palsy develops only with bilateral damage to the cerebral hemispheres, since a break in the paths to the nuclei of one hemisphere does not produce noticeable bulbar disorders. The cause of pseudobulbar palsy is usually atherosclerosis of cerebral vessels with areas of softening in both hemispheres of the brain. However, pseudobulbar palsy can also be observed with the vascular form of cerebral syphilis, neuroinfections, tumors, degenerative processes affecting both hemispheres of the brain.

One of the main symptoms of pseudobulbar palsy is impaired chewing and swallowing. Food gets stuck behind the teeth and on the gums, the patient chokes when eating, liquid food flows out through the nose. The voice takes on a nasal tint, becomes hoarse, loses intonation, difficult consonants are completely dropped out, some patients cannot even speak in a whisper. Due to bilateral paresis of the facial muscles, the face becomes amicable, mask-like, and often has a crying expression. Characterized by attacks of violent convulsive crying and laughter, occurring without appropriate symptoms. Some patients may not have this symptom. Tendon reflex lower jaw rises sharply. Symptoms of so-called oral automatism appear (see). Often pseudobulbar syndrome occurs simultaneously with hemiparesis. Patients often have more or less pronounced hemiparesis or paresis of all extremities with pyramidal signs. In other patients, in the absence of paresis, a pronounced extrapyramidal syndrome appears (see) in the form of slowness of movements, stiffness, increased muscle mass (muscle rigidity). Observed with pseudo bulbar syndrome intellectual impairment is explained by multiple foci of softening in the brain.

The onset of the disease in most cases is acute, but sometimes it can develop gradually. In most patients, pseudobulbar palsy occurs as a result of two or more attacks of cerebrovascular accident. Death occurs from bronchopneumonia caused by food getting into respiratory tract, associated infection, stroke, etc.

Treatment should be directed against the underlying disease. To improve the act of chewing, you need to prescribe 0.015 g 3 times a day with meals.

Pseudobulbar palsy (synonym: false bulbar palsy, supranuclear bulbar palsy, cerebrobulbar palsy) is a clinical syndrome characterized by disorders of swallowing, chewing, phonation and speech articulation, as well as amymia.

Pseudobulbar palsy, in contrast to boulevard paralysis (see), which depends on damage to the motor nuclei of the medulla oblongata, occurs as a result of a break in the paths running from the motor zone of the cerebral cortex to these nuclei. When supranuclear pathways are damaged in both hemispheres of the brain, voluntary innervation of the bulbar nuclei is lost and “false” bulbar palsy occurs, false because anatomically the medulla oblongata itself does not suffer. Damage to the supranuclear tracts in one hemisphere of the brain does not produce noticeable bulbar disorders, since the nuclei of the glossopharyngeal and vagus nerve(as well as the trigeminal and superior branches facial nerve) have bilateral cortical innervation.

Pathological anatomy and pathogenesis. With pseudobulbar palsy, in most cases there is severe atheromatosis of the arteries of the base of the brain, affecting both hemispheres while sparing the medulla oblongata and pons. More often, pseudobulbar palsy occurs due to thrombosis of the cerebral arteries and is observed mainly in old age. In middle age, pseudobulbar palsy can be caused by syphilitic endarteritis. IN childhood pseudobulbar palsy is one of the symptoms of childhood cerebral palsy with bilateral damage to the corticobulbar conductors.

The clinical course and symptomatology of pseudobulbar palsy are characterized by bilateral central paralysis, or paresis of the trigeminal, facial, glossopharyngeal, vagus and hypoglossal cranial nerves in the absence of degenerative atrophy in the paralyzed muscles, preservation of reflexes and disorders of the pyramidal, extrapyramidal or cerebellar systems. Swallowing disorders in pseudobulbar palsy do not reach the level of bulbar palsy; due to weakness of the masticatory muscles, patients eat extremely slowly, food falls out of the mouth; patients choke. If food enters the respiratory tract, it may develop aspiration pneumonia. The tongue is motionless or extends only to the teeth. Speech is insufficiently articulated, with a nasal tint; the voice is quiet, the words are pronounced with difficulty.

One of the main symptoms of pseudobulbar palsy is attacks of convulsive laughter and crying, which are of a violent nature; the facial muscles, which in such patients cannot contract voluntarily, become excessively contracted. Patients may begin to cry involuntarily when showing their teeth, stroking a piece of paper upper lip. The occurrence of this symptom is explained by a break in the inhibitory pathways heading to the bulbar centers, a violation of the integrity of subcortical formations (the optic thalamus, striatum, etc.).

The face acquires a mask-like character due to bilateral paresis of the facial muscles. During attacks of violent laughter or crying, the eyelids close well. If you ask the patient to open or close his eyes, he opens his mouth. This peculiar disorder of voluntary movements should also be classified as one of characteristic features pseudobulbar palsy.

There is also an increase in deep and superficial reflexes in the area of ​​masticatory and facial muscles, as well as the emergence of reflexes of oral automatism. This should include Oppenheim's symptom (sucking and swallowing movements when touching the lips); labial reflex (contraction of the orbicularis oris muscle when tapping in the area of ​​this muscle); Bekhterev's oral reflex (lip movements when tapping with a hammer around the mouth); buccal Toulouse-Wurp phenomenon (movement of the cheeks and lips is caused by percussion on the side of the lip); Astvatsaturov's nasolabial reflex (proboscis-shaped closing of the lips when tapping on the root of the nose). When stroking the patient's lips, a rhythmic movement of the lips and lower jaw occurs - sucking movements, sometimes turning into violent crying.

There are pyramidal, extrapyramidal, mixed, cerebellar and infantile forms of pseudobulbar palsy, as well as spastic.

The pyramidal (paralytic) form of pseudobulbar palsy is characterized by more or less clearly expressed hemi- or tetraplegia or paresis with increased tendon reflexes and the appearance of pyramidal signs.

Extrapyramidal form: slowness of all movements, amymia, stiffness, increased muscle tone of the extrapyramidal type with a characteristic gait (small steps) come to the fore.

Mixed form: a combination of the above forms of pseudobulbar palsy.

Cerebellar form: ataxic gait, coordination disorders, etc. come to the fore.

The childhood form of pseudobulbar palsy is observed with spastic diplegia. The newborn sucks poorly, choke and choke. Subsequently, the child develops violent crying and laughter, and dysarthria is detected (see Infantile paralysis).

Weil (A. Weil) described a familial spastic form of pseudobulbar palsy. With it, along with pronounced focal disorders inherent in pseudobulbar palsy, noticeable intellectual retardation is noted. Similar form was also described by Klippel (M. Klippel).

Since the symptom complex of pseudobulbar palsy is caused mostly by sclerotic lesions of the brain, patients with pseudobulbar palsy often exhibit corresponding mental symptoms: memory loss, difficulty thinking, increased efficiency etc.

The course of the disease corresponds to the variety of causes causing pseudobulbar palsy and the prevalence of the pathological process. The progression of the disease is most often stroke-like with varying periods between strokes. If after a stroke (see) paretic phenomena in the extremities subside, then the bulbar phenomena remain for the most part persistent. More often, the patient's condition worsens due to new strokes, especially with cerebral atherosclerosis. The duration of the disease varies. Death occurs from pneumonia, uremia, infectious diseases, new hemorrhage, nephritis, cardiac weakness, etc.

The diagnosis of pseudobulbar palsy is not difficult. Should be differentiated from various forms boulevard palsy, neuritis of the bulbar nerves, parkinsonism. The absence of atrophy and increased bulbar reflexes speak against apoplectic bulbar palsy. It is more difficult to distinguish pseudobulbar palsy from Parkinson-like disease. It has a slow flow, late stages apoplectic strokes occur. In these cases, attacks of violent crying are also observed, speech is upset, and patients cannot eat on their own. The diagnosis may be difficult only in distinguishing cerebral atherosclerosis from the pseudobulbar component; the latter is characterized by rude focal symptoms, strokes, etc. Pseudobulbar syndrome in these cases may appear as component basic suffering.

Bulbar palsy develops with lesions cranial nerves. Appears with bilateral and, to a lesser extent, with unilateral damage to the caudal groups (IX, X and XII) located in the medulla oblongata, as well as their roots and trunks both inside and outside the cranial cavity. Due to the proximity of the location, bulbar and pseudobulbar palsies are uncommon.

Clinical picture

With bulbar syndrome, dysarthria and dysphagia are noticed. Patients, as a rule, choke on liquid, and in some cases are unable to swallow. In connection with this, saliva in such patients often flows from the corners of the mouth.

With bulbar palsy, the muscles of the tongue begin to atrophy and the pharyngeal and palatal reflexes disappear. In seriously ill patients, as a rule, disorders of the rhythm of breathing and cardiac function develop, which often leads to fatal outcome. This is confirmed by the close location of the centers of the respiratory and cardiovascular system, in connection with which the latter may be involved in the painful process.

Reasons

The factors of this disease are all kinds of ailments leading to damage to brain tissue in this area:

• ischemia or hemorrhage in the medulla oblongata;
• inflammation of any etiology;
• polio;
• neoplasm of the medulla oblongata;
• amyotrophic lateral sclerosis;
• Guillain-Barre syndrome.

In this case, the innervation of the muscles of the soft palate, pharynx and larynx is not observed, which explains the formation of the standard symptom complex.

Symptoms

Bulbar and pseudobulbar palsy have the following symptoms:

• Dysarthria. The speech of patients becomes dull, slurred, slurred, nasal, and sometimes aphonia (loss of sonority of the voice) can be observed.
• Dysphagia. Patients cannot always make swallowing movements, so eating food is difficult. Also in connection with this, saliva often flows out through the corners of the mouth. At advanced cases swallowing and palatal reflexes may disappear completely.

Myasthenia gravis

Myasthenia gravis manifests itself the following symptoms:

• causeless fatigue of various muscle groups;
• double vision;
• omission upper eyelid;
• weakness of facial muscles;
• decreased visual acuity.

Aspiration syndrome

Aspiration syndrome manifests itself:

• ineffective cough;
• difficulty breathing with the involvement of auxiliary muscles and the wings of the nose in the act of breathing;
• difficulty breathing when inhaling;
• wheezing when exhaling.

Breathing pathologies

Most often manifested:

• pain in chest;
• rapid breathing and heart rate;
• shortness of breath;
• cough;
• swelling of the neck veins;
• blue in the face skin;
• loss of consciousness;
• drop in blood pressure.

Cardiomyopathy is accompanied by shortness of breath with great physical activity, chest pain, swelling lower limbs, dizziness.

Pseudobulbar palsy, in addition to dysarthria and dysphagia, is manifested by violent crying and sometimes laughter. Patients may cry when baring their teeth or for no reason.

Difference

The differences are much smaller than the similarities. First of all, the difference between bulbar and pseudobulbar palsy lies in the root cause of the disorder: bulbar syndrome is caused by injury to the medulla oblongata and the nerve nuclei located in it. Pseudobulbar - insensitivity of the cortico-nuclear connections.

Hence the differences in symptoms:

• bulbar palsy is much more severe and poses a greater threat to life (stroke, infections, botulism);
• a reliable indicator of bulbar syndrome is disturbance of breathing and heart rate;
• with pseudobulbar palsy there is no process of muscle reduction and restoration;
• Pseudo-syndrome is indicated by specific movements of the mouth (lips forming a tube, unpredictable grimaces, whistling), unintelligible speech, decreased activity and degradation of intelligence.

Despite the fact that other consequences of the disease are identical or very similar, significant differences are also observed in treatment methods. For bulbar palsy, ventilation, Proserin and Atropine are used, and for pseudobulbar palsy, more attention is paid to blood circulation in the brain, lipid metabolism and lowering cholesterol levels.

Diagnostics

Bulbar and pseudobulbar palsy are disorders of the central nervous system. They are very similar in symptoms, but at the same time have completely different etiologies of occurrence.

The main diagnosis of these pathologies is based primarily on analysis clinical manifestations, focusing on individual nuances (signs) in symptoms that distinguish bulbar palsy from pseudobulbar palsy. It has important, since these ailments lead to different, different consequences for the body.

So, general symptoms For both types of paralysis there are the following manifestations: impaired swallowing function (dysphagia), vocal dysfunction, disorders and speech disorders.

These similar symptoms have one significant difference, namely:

• with bulbar palsy, these symptoms are a consequence of muscle atrophy and destruction;
• with pseudobulbar paralysis, the same symptoms appear due to paresis of the facial muscles of a spastic nature, while the reflexes are not only preserved, but also have a pathologically exaggerated nature (which is expressed in forced excessive laughter, crying, there are signs of oral automatism).

Treatment

If areas of the brain are damaged, the patient may experience quite serious and health-threatening pathological processes that significantly reduce the standard of living and can also lead to death. Bulbar and pseudobulbar palsy are a type of nervous system disorder whose symptoms differ in their etiology, but are similar.

Bulbar develops as a result of improper functioning of the medulla oblongata, namely the nuclei of the hypoglossal, vagus and glossopharyngeal nerves located in it. Pseudobulbar syndrome occurs due to impaired functioning of the corticonuclear pathways. After identifying pseudobulbar palsy, you must initially begin to treat the underlying disease.

So, if a symptom is caused hypertension, vascular and antihypertensive therapy is usually prescribed. For tuberculous and syphilitic vasculitis, antibiotics must be used and antimicrobial agents. Treatment in this case can be carried out by specialized specialists - a phthisiatrician or a dermatovenerologist.

In addition to specialized therapy, the patient is prescribed medical supplies, which help improve microcirculation in the brain, normalize work nerve cells and improve the transmission of nerve impulses to it. For this purpose it is prescribed anticholinesterase drugs, various nootropic, metabolic and vascular agents. The main goal of treatment for bulbar syndrome is to maintain normal level important functions for the body. For the treatment of progressive bulbar palsy the following is prescribed:

• eating using a tube;
• artificial ventilation lungs;
• "Atropine" if available copious discharge saliva;
• "Prozerin" to restore the swallowing reflex.

After possible resuscitation measures, complex treatment is usually prescribed that affects the underlying disease - primary or secondary. This helps ensure the preservation and improvement of the quality of life, as well as significantly alleviate the patient’s condition.

Doesn't exist universal remedy, which would effectively cure pseudobulbar syndrome. In any case, the doctor must select a regimen complex therapy, for which all existing violations are taken into account. Additionally, physical therapy can be used, breathing exercises according to Strelnikova, as well as exercises for poorly functioning muscles.

As practice shows, it is not possible to completely cure pseudobulbar palsy, since such disorders develop as a result of severe brain damage, moreover, bilateral. They can often be accompanied by destruction of nerve endings and the death of many neurons.

Treatment makes it possible to compensate for disturbances in the functioning of the brain, and regular rehabilitation sessions allow the patient to adapt to new problems. So, you should not refuse the doctor’s recommendations, as they help slow down the progression of the disease and put the nerve cells in order. Some experts recommend for effective treatment introduce stem cells into the body. But this is a rather debatable issue: according to proponents, these cells help restore neuronal function and physically replace mycelin. Opponents believe that the effectiveness of this approach has not been proven, and may even provoke the growth of cancerous tumors.

With a pseudobulbar symptom, the prognosis is usually serious, and with a bulbar symptom, the cause and severity of the development of paralysis are taken into account. Bulbar and pseudobulbar syndromes are severe secondary lesions of the nervous system, the treatment of which should be aimed at curing the underlying disease and always in a comprehensive manner.

If treated incorrectly and untimely, bulbar palsy can cause cardiac and respiratory arrest. The prognosis depends on the course of the underlying disease or may even remain unclear.

Consequences

Despite similar symptoms and manifestations of bulbar and pseudobulbar disorders have various etiologies and, as a consequence, lead to different consequences for the body. With bulbar palsy, symptoms manifest themselves as a result of muscle atrophy and degeneration, so if urgent resuscitation measures are not taken, the consequences can be severe. In addition, when lesions affect the respiratory and cardiovascular areas of the brain, respiratory distress and heart failure may develop, which, in turn, can be fatal.

Pseudobulbar palsy does not have atrophic muscle lesions and is antispasmodic in nature. Localization of pathologies is observed above the medulla oblongata, so there is no threat of respiratory arrest and cardiac dysfunction, and there is no threat to life.

To the main negative consequences Pseudobulbar palsy may include:

• unilateral paralysis of body muscles;
• paresis of the limbs.

In addition, due to softening of certain areas of the brain, the patient may experience memory impairment, dementia, and impaired motor functions.

Bulbar palsy develops with simultaneous bilateral or unilateral damage to the subcortical nuclei of the glossopharyngeal, vagus, accessory and hypoglossal nerves, which are located in the medulla oblongata. Refers to peripheral paralysis, that is, it is characterized by a drop in muscle tone, suppression of reflexes and the development of muscle atrophy.

The causes of this syndrome are any diseases leading to damage to brain tissue in this area:

• ischemia or hemorrhage in the medulla oblongata;
• any etiology (tick-borne, herpetic, etc.);
• polio;
• tumor of the medulla oblongata;
• Guillain-Barre syndrome.

In this case, there is a disruption in the innervation of the muscles of the soft palate, pharynx and larynx, which causes the development of a typical symptom complex.

Signs of bulbar palsy

Characteristic of bulbar palsy and paresis is a combination of a number of symptoms caused by impaired movements of the muscles of the soft palate, pharynx, and larynx. The first thing that attracts attention is the appearance of difficulties in swallowing and choking when eating food or water.

This condition is dangerous due to the entry of food and water particles into the nose and lungs. If in the first case only discomfort, then in the latter an acute respiratory failure and death. Therefore, feeding of patients with bulbar palsy or paresis must be carefully organized.

Difficulties arise in pronouncing words (, especially those containing the letter “r”. Vowels and voiced consonants are pronounced dullly. Speech becomes slurred, unclear, “mess in the mouth.” The voice changes, it becomes hoarse, hoarse and nasal, loses its sonority (aphonia). It seems as if the person is speaking “through the nose”, as in severe cold(nasolalia). Words are spoken at a slow pace; a person quickly gets tired of the conversation.

On examination, a decrease in tongue mobility is noted. Twitching of its individual muscle bundles (fasciculations) is visible. Over time, the muscles of the tongue atrophy and it decreases in size. The soft palate hangs over the pharynx. The pharyngeal, cough and palatal reflexes fade away.

Sometimes patients with bulbar palsy experience Brissot syndrome, which is most likely associated with inhibition of the function of the reticular formation at the level of the medulla oblongata. Manifests sudden occurrence trembling all over the body, the skin turns pale, sweat appears on it. Breathing disturbances appear, blood pressure drops, palpitations and a feeling of interruptions in the functioning of the heart occur. This is accompanied by a feeling of severe anxiety and panic.

Important! Next to the nuclei of the cranial nerves responsible for the development of symptoms of bulbar palsy, there are centers for regulating breathing and heartbeat. Therefore, manifestations of this syndrome are often accompanied by a cessation of vital functions.

What is the difference between pseudobulbar palsy?

It develops when the pathways running from the cortex to the nuclei of these nerves are damaged, that is, the lesion is located higher than in bulbar palsy. It belongs to central type paralysis. Their features are an increase in muscle tone, the appearance of pathological reflexes, and the absence of muscle atrophy.

Dysarthria and aphonia resemble manifestations of bulbar palsy. The voice becomes weak, hoarse, and the pronunciation of most sounds is impaired. The reason for this is the increased tone of the muscles of the tongue and soft palate. Therefore, an attempt to pronounce words more clearly leads to an even greater deterioration in diction, since the spasmed muscles become more tense.

It is easier to induce pharyngeal and cough reflexes. Reflexes of oral automatism appear, which are normally absent in an adult: when the mouth area is irritated, the lips are pulled out like a tube, the person makes sucking movements.

A characteristic sign is the development of violent crying or laughter. The appropriate facial expressions appear spontaneously, without volitional effort and do not correspond to the real situation.

Therapy methods

Treatment of bulbar palsy begins with eliminating the underlying cause that caused the disease. To alleviate the condition, drugs are prescribed that improve the nutrition of nerve cells: Piracetam, Phenotropil, Cerebrolysin, Cerepro, Cytoflavin and others.

Cerebral circulation improve drugs like Vinpocetine. B vitamins, especially B1 and B6, help improve impulse transmission along the nerve fiber and participate in the formation of its sheath. Therefore, they are also the drug of choice for diseases of the nervous system.

Organization is important proper care for such a patient. Feeding must be done in the presence of a nurse or other caregiver to prevent choking and foreign bodies into the lungs. Physiotherapeutic procedures, classes with a speech therapist and a neuropsychologist help improve speech skills.

Bulbar and pseudobulbar palsy are only a manifestation of some other disease of the nervous system. If these signs develop, it is necessary to contact a neurologist as soon as possible and undergo all the necessary examinations, since usually these syndromes indicate severe damage to the nervous system, which can lead to death.