Bulbar syndrome manifests itself. Swallowing dysfunction or bulbar palsy

As a result of disruption of the functioning of certain elements of the brain, a person may develop pseudobulbar syndrome (cranial nerve damage syndrome).

The mechanism of the pathological condition is based on a disruption of the activity of nerve cells located in the medulla oblongata. Despite the fact that the problem significantly reduces a person’s quality of life, it does not pose a significant threat to his health.

The complete opposite in this regard are bulbar disorders, which can lead to paralysis of the smooth muscles of the tongue, pharynx or vocal cords. The patient's speech is impaired; it becomes difficult for him to breathe and swallow.

Timely detection and subsequent differential diagnosis of syndromes with a similar clinical picture allows the doctor to select adequate therapeutic measures.

Mechanism of occurrence

If the main parts of the nervous system are damaged, human life is supported by the autonomous functioning of certain elements. Their work is not regulated by the cerebral cortex.

These elements are neurons. Their independent activity leads to the fact that complex motor acts (breathing, swallowing, speech) are carried out with disturbances.

Coordinated activity of different muscle groups is possible only with the clearest possible coordination in the work of different parts of the brain. The autonomous functioning of subcortical structures cannot ensure this.

When the higher sections cease to regulate the motor nuclei (a collection of nerve cells) located in the medulla oblongata, a person develops pseudobulbar syndrome.

The absence of a “manager” activates the operation of the cores in autonomous mode.

Such isolated activities have the following consequences:

• complete preservation of the functioning of vital systems of the body (cardiovascular and respiratory);
• paralysis of the soft palate leads to impaired swallowing;
• speech becomes unintelligible;
• inactivity of the vocal cords and impaired phonation.

Spontaneous contraction of the facial muscles leads to the appearance of grimaces that imitate various emotional situations.

Understanding the development process of any disease allows doctors to promptly and promptly select an effective treatment regimen.

Causes

This syndrome occurs as a result of damage to the neural pathways through which information from the cerebral cortex enters the nuclei.

In the vast majority of cases, the main causes of this disorder may be the following conditions:

• hypertension (high blood pressure), which favors the development of;
• the presence of atherosclerotic plaques in the arterioles of the brain;
• circulatory disorders caused by unilateral damage to the blood vessels supplying the brain;
• traumatic brain injuries of various types;
• vasculitis arising from diseases such as tuberculosis or syphilis;
• brain injury during childbirth;
• metabolic disorders with long-term use of drugs containing valproic acid;
• malignant neoplasms and benign tumors in the frontal lobes or subcortical structures;
• inflammation of brain tissue caused by diseases of infectious etiology.

Pseudobulbar syndrome mainly develops as a result of many chronic processes that are at the stage of progression. Acute oxygen starvation is a factor that also contributes to the development of this unpleasant condition.

Clinical symptoms

A characteristic feature of pseudobulbar syndrome is the fact that patients suffering from this disorder may laugh or cry against their own will.

The process of swallowing and articulation are disrupted, and various grimaces appear on the face.

Due to the fact that the muscles of the palate and pharynx are weakened, swallowing is preceded by a tickling sensation and the appearance of slight pauses. There is no atrophy or twitching of the affected muscles.

Damage to the cranial nerves often results in speech impairment, with only pronunciation affected. Blurred articulation is combined with a dull voice.

The appearance of forced laughter or involuntary crying is caused by a short-term spasm of the facial muscles. Such behavior is absolutely unrelated to the emotional impressions suffered and is carried out involuntarily.

Often there are symptoms indicating a violation of voluntary movements of facial muscles. It is for this reason that if the patient is asked to close his eyes, he may open his mouth.

Pseudobulbar syndrome is not an isolated disease. This disorder is mainly accompanied by some other neurological disorders.

The clinical picture and the degree of its severity are largely determined by the main reason that activated the pathology. If the frontal lobes are affected, the syndrome manifests itself as symptoms of an emotional-volitional disorder. The patient may experience apathy, loss of interest in what is happening around him, poor activity or lack of initiative.

Impaired motor functions appear if elements of the subcortical zone are damaged. The main task of doctors is to correctly differentiate the relatively harmless pseudobulbar syndrome from a life-threatening bulbar disease.

Bulbar disorder

Bulbar syndrome occurs due to damage to the nuclei located in the medulla oblongata.

These nuclei are clusters of cells of the nervous system and take an active part in regulating the coordination of movements, the formation of emotions and other vital functions.

Violations can develop for the following reasons:

• mechanical compression and injury to the nuclei as a result of a benign or malignant brain tumor;
• background circulatory failure;
• viral diseases affecting the nervous system;

Damage to the nuclei leads to the development of a pathological condition, the characteristic feature of which is severe peripheral paralysis.

Degenerative changes in the muscles of the pharynx or soft palate make it difficult for a person to swallow and speak.

The nature of the clinical picture is largely determined by the degree of damage to nerve cells.

The main symptoms are:

• increased salivation;
• there is no facial expression;
• half-open mouth;
• the soft palate hangs down;
• finding the tongue outside the oral cavity with a characteristic deviation to the side and short-term twitching;
• difficult to understand speech;
• weakening or complete loss of voice during a conversation.

Bulbar syndrome is accompanied by disruption of the cardiovascular system and respiratory organs.

As a result, the patient experiences a weak or rapid pulse, as well as deviations in the heartbeat rhythm.

There is a disruption in breathing movements with the appearance of pauses in the breathing process.

Treatment

If pseudobulbar syndrome is detected, the doctor determines a treatment regimen that will focus on the treatment of the underlying disease. If the disease has developed as a result of hypertension, therapy is prescribed aimed at reducing blood pressure and normalizing the functioning of the cardiovascular system.

Antibacterial drugs are effective for vasculitis due to or.

An important element of an integrated approach are medications that improve microcirculation in the brain and normalize the activity of the central and peripheral nervous system.

There is currently no classical treatment regimen for pseudobulbar syndrome.

The therapeutic course is drawn up based on the disorders present in the patient.

This approach is an important part of complex therapy.

However, adequate drug therapy and special classes aimed at speedy rehabilitation favor the fact that a person gradually adapts to the problems that have arisen.

Bulbar and pseudobulbar syndromes have many similarities with each other. They are rightfully serious pathologies of the nervous system.

When structural elements of the brain are damaged, the risk of disruption of the functioning of vital systems and organs increases significantly.

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Higher education (Cardiology). Cardiologist, therapist, functional diagnostics doctor. I am well versed in the diagnosis and treatment of diseases of the respiratory system, gastrointestinal tract and cardiovascular system. Graduated from the Academy (full-time), with extensive work experience behind her. Specialty: Cardiologist, Therapist, Functional Diagnostics Doctor. .

1. Motor neuron diseases (amyotrophic lateral sclerosis, Fazio-Londe spinal amyotrophy, Kennedy bulbospinal amyotrophy).
2. Myopathies (oculopharyngeal, Kearns-Sayre syndrome).
3. Dystrophic myotonia.
4. Paroxysmal myoplegia.
5. Myasthenia.
6. Polyneuropathy (Guillain-Barré, post-vaccination, diphtheria, paraneoplastic, with hyperthyroidism, porphyria).
7. Polio.
8. Processes in the brain stem, posterior cranial fossa and craniospinal region (vascular, tumor, syringobulbia, meningitis, encephalitis, granulomatous diseases, bone anomalies).
9. Psychogenic dysphonia and dysphagia.

Motor neuron diseases

The end stage of all forms of amyotrophic lateral syndrome (ALS) or the onset of its bulbar form are typical examples of bulbar dysfunction. Usually the disease begins with bilateral damage to the nucleus of the XII nerve and its first manifestations are atrophy, fasciculations and paralysis of the tongue. In the first stages, dysarthria without dysphagia or dysphagia without dysarthria may occur, but quite quickly there is a progressive deterioration of all bulbar functions. At the onset of the disease, difficulty swallowing liquid food is observed more often than solid food, but as the disease progresses, dysphagia develops when eating solid food. In this case, the weakness of the tongue is accompanied by weakness of the masticatory and then facial muscles, the soft palate hangs down, the tongue in the oral cavity is motionless and atrophic. Fasciculations are visible in it. Anarthria. Constant drooling. Weakness of the respiratory muscles. In the same area or in other regions of the body, symptoms of upper motor neuron involvement are detected.

Criteria for the diagnosis of amyotrophic lateral sclerosis

• the presence of signs of damage to the lower motor neuron (including EMG - confirmation of the anterior horn process in clinically intact muscles); clinical symptoms of upper motor neuron damage (pyramidal syndrome); progressive course.

“Progressive bulbar palsy” is today considered as one of the variants of the bulbar form of amyotrophic lateral sclerosis (just like “primary lateral sclerosis” as another type of amyotrophic lateral sclerosis, occurring without clinical signs of damage to the anterior horns of the spinal cord).

Increasing bulbar palsy can be a manifestation of progressive spinal amyotrophy, in particular, the terminal stage of Werdnig-Hoffmann amyotrophy, and in children, Fazio-Londe spinal amyotrophy. The latter refers to autosomal recessive spinal amyotrophies with onset in early childhood. In adults, X-linked bulbar spinal amyotrophy is known, beginning at the age of 40 years and older (Kennedy disease). Characterized by weakness and atrophy of the muscles of the proximal parts of the upper extremities, spontaneous fasciculations, limited range of active movements in the arms, decreased tendon reflexes in the biceps and triceps brachii muscles. As the disease progresses, bulbar (usually mild) disorders develop: choking, tongue atrophy, dysarthria. The leg muscles are involved later. Characteristic features: gynecomastia and pseudohypertrophy of the calf muscles.

With progressive spinal amyotrophies, the process is limited to damage to the cells of the anterior horns of the spinal cord. Unlike amyotrophic lateral sclerosis, the process here is always symmetrical, it is not accompanied by symptoms of upper motor neuron involvement and has a more favorable course.

Myopathies

Some forms of myopathies (oculopharyngeal, Kearns-Sayre syndrome) may manifest as impaired bulbar functions. Oculopharyngeal myopathy (dystrophy) is a hereditary (autosomal dominant) disease, characterized by a late onset (usually after 45 years) and muscle weakness, which is limited to the facial muscles (bilateral ptosis) and bulbar muscles (dysphagia). Ptosis, swallowing disorders and dysphonia progress slowly. The main maladaptive syndrome is dysphagia. The process extends to the limbs only in some patients and in the later stages of the disease.

One of the forms of mitochondrial encephalomyopathy, namely Kearns-Sayre syndrome (“ophthalmoplegia plus”), manifests itself, in addition to ptosis and ophthalmoplegia, with a myopathic symptom complex that develops later than eye symptoms. Involvement of the bulbar muscles (larynx and pharynx) is usually not severe enough, but can lead to changes in phonation and articulation, and choking.

Obligate signs of Kearns-Sayre syndrome:

• external ophthalmoplegia
• retinal pigmentary degeneration
• cardiac conduction disorders (bradycardia, atrioventricular block, syncope, sudden death possible)
• increased protein levels in the cerebrospinal fluid

Dystrophic myotonia

Dystrophic myotonia (or Rossolimo-Kurshman-Steinert-Batten myotonic dystorophy) is inherited in an autosomal dominant manner and affects men 3 times more often than women. Her debut occurs at the age of 16-20 years. The clinical picture consists of myotonic, myopathic syndromes and extramuscular disorders (dystrophic changes in the lens, testicles and other endocrine glands, skin, esophagus, heart and sometimes in the brain). Myopathic syndrome is most pronounced in the muscles of the face (masticatory and temporal muscles, which leads to a characteristic facial expression), neck and, in some patients, in the limbs. Damage to the bulbar muscles leads to a nasal tone of voice, dysphagia and choking, and sometimes to respiratory disorders (including sleep apnea).

Paroxysmal myoplegia (periodic paralysis)

Paroxysmal myoplegia is a disease (hypokalemic, hyperkalemic and normokalemic forms), manifested by generalized or partial attacks of muscle weakness (without loss of consciousness) in the form of paresis or plegia (up to tetraplegia) with decreased tendon reflexes and muscle hypotonia. The duration of attacks varies from 30 minutes to several days. Provoking factors: rich carbohydrate-rich food, abuse of table salt, negative emotions, physical activity, night sleep. Only in some attacks there is involvement of the cervical and cranial muscles. Rarely the respiratory muscles are involved in the process to one degree or another.

Differential diagnosis carried out with secondary forms of myoplegia, which occur in patients with thyrotoxicosis, with primary hyperaldosteronism, hypokalemia in some gastrointestinal diseases, and kidney diseases. Iattrogenic variants of periodic paralysis have been described when prescribed drugs that promote the removal of potassium from the body (diuretics, laxatives, licorice).

Myasthenia gravis

Bulbar syndrome is one of the dangerous manifestations of myasthenia gravis. Myasthenia gravis is a disease whose leading clinical manifestation is pathological muscle fatigue, which decreases until complete recovery after taking anticholinesterase drugs. The first symptoms are often dysfunctions of the extraocular muscles (ptosis, diplopia and limited mobility of the eyeballs) and facial muscles, as well as the muscles of the limbs. In approximately one third of patients, involvement of the masticatory muscles, muscles of the pharynx, larynx and tongue is observed. There are generalized and local (mainly ocular) forms.

Differential diagnosis myasthenia gravis is carried out with myasthenic syndromes (Lambert-Eaton syndrome, myasthenic syndrome with polyneuropathies, myasthenia-polymyositis complex, myasthenic syndrome with botulinum intoxication).

Polyneuropathy

Bulbar palsy in polyneuropathies is observed in the picture of a generalized polyneuropathic syndrome against the background of tetraparesis or tetraplegia with characteristic sensory disorders, which facilitates the diagnosis of the nature of bulbar disorders. The latter are characteristic of such forms as acute demyelinating polyneuropathy Guillain-Barré, post-infectious and post-vaccination polyneuropathy, diphtheria and paraneoplastic polyneuropathy, as well as polyneuropathy in hyperthyroidism and porphyria.

Polio

Acute poliomyelitis, as a cause of bulbar palsy, is recognized by the presence of general infectious (preparalytic) symptoms, the rapid development of paralysis (usually in the first 5 days of illness) with greater damage to the proximal parts than the distal ones. A period of reverse development of paralysis soon after its appearance is characteristic. There are spinal, bulbar and bulbospinal forms. The lower extremities are most often affected (in 80% of cases), but the development of hemitype or cross-type syndromes is possible. Paralysis is sluggish in nature with loss of tendon reflexes and rapid development of atrophy. Bulbar palsy can be observed in the bulbar form (10-15% of the entire paralytic form of the disease), in which the nuclei of not only the IX, X (less often XII) nerves, but also the facial nerve are affected. Damage to the anterior horns of segments IV-V can cause respiratory paralysis. In adults, the bulbospinal form more often develops. Involvement of the reticular formation of the brain stem can lead to cardiovascular (hypotension, hypertension, cardiac arrhythmias), respiratory (“atactic breathing”) disorders, swallowing disorders, and disturbances in the level of wakefulness.

Differential diagnosis carried out with other viral infections that can affect the lower motor neuron: rabies and herpes zoster. Other diseases that often require a differential diagnosis from acute polio include Guillain-Barré syndrome, acute intermittent porphyria, botulism, toxic polyneuropathies, transverse myelitis, and acute spinal cord compression due to epidural abscess.

There are many neurological diseases, but some of them are especially dangerous and difficult to cure. Among them, bulbar syndrome stands out, in which patients have difficulty even eating food on their own. It is very important to respond in a timely manner to the appearance of alarming symptoms, since delay in this case can lead to serious complications.

What is bulbar syndrome

Bulbar palsy is a serious secondary disease that is associated with damage to certain brain structures. Patients experience deviations in the functioning of the nuclei and roots of the bulbar group of cranial nerves. Each of them has its own special and very important functions, which begin to gradually decrease and even disappear completely:

Due to damage to these muscle groups, patients gradually develop problems with swallowing, speech pronunciation, and nasal and hoarseness. Various vital functions are also affected. Since bulbar palsy is a secondary disease, all patients are diagnosed with serious diseases, such as stroke, brain tumors, encephalitis and many others.

This disease has several synonyms: bulbar palsy, bulbar paresis, bulbar disorder syndrome.

Video about bulbar palsy and methods of its treatment

The difference between pathology and pseudobulbar palsy

There is a disease with a similar name - pseudobulbar syndrome, which has several special differences.

1. Pseudobulbar syndrome does not arise due to disturbances in the functioning of the medulla oblongata, but due to abnormalities in the conductivity of the corticonuclear pathways.
2. The disease occurs against the background of such pathologies as vasculitis, hypertensive cerebral infarctions, Pick's disease, Parkinson's, etc.
3. There are no atrophic changes in the tongue.
4. Sometimes hemiparesis develops, in which the muscles on one side of the body are paralyzed.
5. There is no atrophy of the facial and laryngeal muscles, and there is no twitching of individual muscle fibers.
6. Patients experience a proboscis reflex, or oral automatism. If you tap near the mouth or on the nose, the patient stretches out his lips with a tube.
7. Patients experience violent crying and laughter due to spasms of facial muscles.
8. The facial muscles are uniformly paralyzed.
9. There are no deaths due to respiratory arrest or disruption of the cardiovascular system.

Causes and development factors

Damage to the nuclei of the bulbar nerves occurs due to various diseases that lead to disruption of the central nervous system. Most often, when bulbar syndrome appears in patients, the following primary pathologies are detected:

• stem stroke, which affected the medulla oblongata;
• infectious brain lesions due to tick-borne borreliosis, polyradiculoneuritis;
• tumor formations of the brain stem;
• botulinum toxin poisoning;
• brain damage due to neurosyphilis;
• multiple sclerosis;
• fractures of the base of the skull;
• injuries that led to displacement of parts of the brain;
• perverted hematopoiesis (porphyria);
• Kennedy bulbospinal amyotrophy;
• syringomyelia;
• motor neuron disease.

Another common cause is hypertension, which gradually worsens the patient’s health. Developed atherosclerosis and vasospasm leads to cerebral ischemia, which contributes to the appearance of bulbar syndrome. In rare cases, the primary disease may be a Chiari malformation, which is based on a violation of the anatomical structure and location of the cerebellum and medulla oblongata.

Causes of bulbar syndrome - photo gallery

Stroke is the most common cause of bulbar syndrome The nuclei of the bulbar group can be damaged by the tumor Fractures of the base of the skull contribute to brain damage Progressive diseases of the nervous system - the cause of bulbar syndrome
The effects of toxins negatively affect brain function

Symptoms, including movement disorders

There are several types of bulbar palsy:

1. Acute usually occurs as a result of a rapidly developing primary disease, such as stroke, encephalitis, cerebral edema, or serious skull injuries.
2. Progressive develops gradually and is most often associated with various diseases of the central nervous system, such as Kennedy amyatrophy, neurosyphilis, and brain tumors.

Also, bulbar syndrome can be unilateral or bilateral.

Basically, the disease affects the motor activity of the muscles of the pharynx, larynx and tongue, resulting in three main symptoms that are characteristic of bulbar palsy:

Patients' facial expressions are impaired and their facial expressions become expressionless. The patient's mouth is slightly open, salivation is noted, and chewed food falls out. However, the most dangerous symptoms are impaired respiratory function and the functioning of the cardiovascular system, which can lead to death. These severe manifestations appear due to damage to the vagus nerve.

When examining the oral cavity, changes in the appearance of the tongue are revealed; it becomes folded, uneven and periodically twitches randomly. If a patient has unilateral bulbar palsy, then the soft palate sags only on one side, the tongue also changes only in a certain area and when pulled out of the mouth it bends towards the affected side. In the case of a bilateral disorder, complete immobility of the tongue may occur, which is called glossoplegia.

Due to damage to the hypoglossal nerve, the functioning of the salivary glands is disrupted, and many patients begin to suffer from hypersalivation. When combined with impaired swallowing, this often causes drooling. In some patients, this symptom is so severe that they constantly have to use a handkerchief.

Diagnostics

At the first signs of bulbar palsy, you should contact a neurologist. During the initial examination, the doctor will check the speed and intelligibility of word pronunciation, voice timbre, volume of salivation, and will also examine the appearance of the tongue and the presence of a swallowing reflex. It is very important to assess your breathing and heart rate. Using a laryngoscope, you can determine how much closure of the vocal cords has occurred.

To identify the primary disease, you may need to undergo various additional diagnostic methods:

Additional studies are also prescribed:

• general blood analysis;
• general urine analysis;
• cerebrospinal fluid examination.

Thanks to CT and MRI, it is possible to identify various abnormalities in the structure of the brain, as well as detect tumors, edema, cysts and areas of hemorrhage.

Differential diagnosis is carried out to exclude pseudobulbar palsy, psychogenic dysphagia and dysphonia, various types of myopathies in which paralysis of the muscles of the larynx and pharynx occurs (myasthenia gravis, oculopharyngeal and paroxysmal myopathies).

Treatment

Since bulbar syndrome is usually a secondary disease, it is necessary to eliminate the primary pathology. Unfortunately, most of them are incurable and progress throughout life. As patients recover, they will experience less paralysis and gradual recovery of muscle function. A very important task that doctors face is to preserve all body functions in the patient. In severe forms of bulbar syndrome, the patient may need artificial ventilation.

Patients with bulbar palsy need the help of loved ones, as they may have many difficulties with both eating and social life. It is very important to be with the patient while eating to help him if aspiration occurs.

Drug therapy

There are many pharmacological drugs that can be prescribed for bulbar palsy:

1. Synthetic cholinesterase inhibitors are necessary to restore muscle function (Prozerin). The swallowing reflex and gastric motility improve, blood pressure decreases and the pulse slows.
2. M-cholinergic receptor blockers are necessary for profuse and uncontrolled salivation (Atropine).
3. Various antibiotics are needed in the treatment of infection.
4. Decongestant diuretics are necessary for cerebral edema (Furosemide, Torasemide).
5. Vasoactive drugs are necessary in the presence of vascular disorders (Parmidin, Alprostan).
6. B vitamins are necessary for maintaining and restoring the nervous system (Neuromultivit, Milgamma, Vitagamma).
7. Preparations with glutamic acid stimulate metabolic processes in the central nervous system.

Drugs for the treatment of bulbar syndrome - photo gallery

Prozerin improves muscle function
Atropine eliminates salivation Furosemide is used to relieve cerebral edema Milgamma normalizes brain function Ceftriaxone is a broad-spectrum antibiotic for the treatment of infections.

Nutritional Features

In advanced stages, when it becomes impossible for the patient to eat on his own, feeding through a tube is prescribed. The patient is fitted with a special nasogastric or gastric feeding tube, through which various balanced mixtures are supplied. It is necessary to undergo instruction from medical personnel in order to independently carry out this procedure at home.

With the help of a doctor, you need to select a special diet that will provide the patient with a balanced diet in order to maintain health and speed up the healing process. Food is introduced only in liquid form; the presence of lumps or solid elements is not allowed. Usually special preparations are used that have a homogeneous structure and easily pass through the tube. One of these products is Nutrizon, which is available both in the format of a ready-made drink and in powder. It contains the required amount of proteins, fats and carbohydrates, as well as microelements and vitamins.

After feeding, the tube can be left for about five days, then it must either be replaced or thoroughly rinsed and disinfected. The syringes themselves for administering food must be cleaned every time after eating.

Video about enteral feeding using a nasogastric tube

Physiotherapeutic methods

Patients need to attend therapeutic massage sessions, where they will be helped to develop muscles and speed up the process of their recovery. Initially, the front surface of the neck is being worked on. With the patient lying down, the sternocleidomastoid muscles are massaged along the lymphatic vessels. The inner surface of the mouth, palate and tongue are also developed.

Patients with bulbar palsy are prescribed kinesitherapy, a type of therapeutic exercises. It is often combined with breathing exercises to speed up recovery and develop the lungs. There are several specific exercises that are prescribed for bulbar palsy. When performing them, the specialist helps the patient by passively moving the muscles and larynx with his hands in the desired direction:

1. To stimulate the laryngopharyngeal and swallowing muscles, patients perform an exercise - putting the lower jaw on the upper and vice versa. In a sitting position, you need to take a slow and deep breath, move your lower jaw forward and then forcefully close your jaws. Afterwards, you need to exhale, return to the starting position and move the lower jaw back as much as possible, and cover it with the front one. In this case, patients nod their heads, which stimulates the muscles of the pharynx and larynx.
2. While sitting or standing, begin to press your chin to your neck as much as possible. As you inhale, raise your head, as you exhale, lower it.
3. In a lying position, squeeze your jaws forcefully, pull the corners of your mouth towards your ears and make swallowing movements.
4. In a lying position, begin to lift your head from the pillow as you inhale and slowly lower it as you exhale.

Video about therapeutic exercises for bulbar palsy

Surgical intervention

Surgery is prescribed for various diseases that cannot be cured conservatively. In case of tumor formations, surgical removal is sometimes indicated. In case of fractures, surgery may be prescribed to eliminate the consequences of the injury and restore the integrity of the skull.

Features in children, including newborns

In children, bulbar palsy can often develop due to hypoxia or various injuries received during childbirth. In newborn babies, already in the first weeks of life, doctors resort to restoring reflexes. In addition to medications, babies need massage and physiotherapeutic procedures. However, these measures do not always help improve the child’s condition, and the primary disease progresses quickly. During examination, the pediatrician often notes increased moisture in the oral cavity, and during crying, the tip of the tongue is visible. Sometimes parents notice a violation of facial expressions in a newborn, the face becomes motionless, and he cannot swallow milk or formula on his own.

For many children, classes with a speech therapist become a necessity. Due to atrophy of the muscles of the face and tongue, the child’s speech may be impaired, it becomes slurred, which significantly impairs his social adaptation and ability to learn.

Treatment prognosis and possible complications

The prognosis of treatment for bulbar palsy is very variable and greatly depends on what kind of primary disease was detected in the patient. If you can get rid of it in the shortest possible time, then all body functions can also quickly recover. However, in severe cases, deaths due to respiratory and cardiovascular failure are recorded. The most unfavorable prognosis is for those patients who have a constantly progressive disease of the central nervous system.

Prevention

To prevent bulbar syndrome, it is necessary to carefully monitor your health and promptly treat all emerging diseases. It is also important to avoid brain injuries and be vaccinated against infectious pathologies. There are tips that can help avoid the occurrence of many diseases in the future:

Bulbar syndrome, or, as it is also called, bulbar palsy, is a disease caused by changes in activity or damage to certain parts of the brain, causing disruption of the functioning of the organs of the mouth or pharynx.

This is paralysis of the organs of direct food intake or speech, in which the lips, palate, pharynx (upper part of the esophagus, tongue, small uvula, lower jaw) are paralyzed. This disease can be bilateral or unilateral, affecting half of the pharynx in a longitudinal section.

The following symptoms are observed with the disease:

• Lack of facial expressions of the mouth: the patient simply cannot use it.
• Constantly open mouth.
• Entry of liquid food into the nasopharynx or trachea.
• There are no palatal and pharyngeal reflexes; a person stops involuntarily swallowing, including saliva).
• Due to the previous symptom, drooling develops.
• If one-sided paralysis occurs, the soft palate hangs down, and the uvula is pulled to the healthy side.
• Slurred speech.
• Inability to swallow
• Paralysis of the tongue, which may constantly twitch or be in an outward position, hanging out of the mouth.
• Breathing is impaired.
• There is a deterioration in heart activity.
• The voice disappears or becomes dull and barely audible, changes its tone and becomes completely different from the previous one.

Patients are often unable to swallow, so they are forced to eat liquid food through a tube.

In medicine, a distinction is made between bulbar and pseudobulbar syndromes, which have very similar symptoms, but are still slightly different, have different causes, although they are related in origin.

During pseudobulbar palsy, the palatal and pharyngeal reflexes are preserved, and tongue paralysis does not occur, but swallowing impairment still develops; most patients show symptoms of forced laughter or crying when touching the palate.

Both paralysis occurs as a result of damage to the same parts of the brain for the same reasons, but bulbar syndrome develops due to damage to the brain nuclei responsible for the functions of swallowing, heartbeat, speech or breathing, and pseudobulbar syndrome develops from damage to the subcortical pathways from these nuclei to the nerves bulbar group responsible for these functions.

At the same time, pseudobulbar syndrome is a less dangerous pathology that does not entail the risk of sudden cardiac or respiratory arrest.

What causes the symptoms

Symptoms of the pathology are caused by damage to an entire group of brain organs, specifically the nuclei of several nerves located in the medulla oblongata, their intracranial or external roots. With bulbar syndrome, damage to any one nucleus almost never occurs with the loss of only one function, since these organs are located very close to each other and also have a very small size, which is why they are affected simultaneously.

Due to the lesion, the nervous system loses connection with the organs of the pharynx and can no longer control them either consciously or unconsciously at the level of reflexes (when a person automatically swallows saliva).

A person has 12 pairs of cranial nerves, which appear in the second month of prenatal life, which consist of brain matter and are located in the very center of the brain between its hemispheres. They are responsible for the human senses and the functioning of the face as a whole. At the same time, they have motor, sensory function, or both at once.

The nerve nuclei are unique command posts: ternary, facial, glossopharyngeal, hypoglossal, etc. Each nerve is paired, so their nuclei, which are located symmetrically relative to the medulla oblongata, are also paired. In bulbar syndrome, the nuclei responsible for the glossopharyngeal, hypoglossal or vagus nerve are affected, which has mixed functions in innervating the pharynx, soft palate, larynx, esophagus, and has a parasympathetic effect (exciting and contracting) on ​​the stomach, lungs, heart, intestines, pancreas, responsible for the sensitivity of the mucous membrane of the lower jaw, pharynx, larynx, part of the auditory canal, eardrum and other less important parts of the body. Since the nuclei are paired, they can be damaged either completely or only half of them, located on one side of the medulla oblongata.

Impairment or damage to the vagus nerve in bulbar palsy can cause a sudden stop in the contractions of the heart, respiratory system, or disruption of the gastrointestinal tract.

Causes of the disease

Brain disorders that cause bulbar syndrome can have a huge number of causes, which can be grouped into several general groups:

• Hereditary abnormalities, mutations and organ changes.
• Brain diseases, both traumatic and infectious.
• Other infectious diseases.
• Toxic poisoning.
• Vascular changes and tumors.
• Degenerative changes in brain and nerve tissue.
• Bone abnormalities.
• Disorders of intrauterine development.
• Autoimmune disorders.

Each group contains a large number of individual diseases, each of which can cause complications on the bulbar group of nuclei of the brain and on its other parts.

Bulbar palsy in children

In newborns, bulbar palsy is very difficult to determine; it is diagnosed according to two criteria:

• Too high humidity in the mucous membrane of the baby's mouth, which in infants is almost dry.
• Retract the tip of the tongue to the side if the hypoglossal nerve is affected.

Bulbar syndrome in children is extremely rare, since all brain stems are affected, which is fatal. Such babies simply die immediately. But pseudobulbar syndrome in children is common and is a type of cerebral palsy.

Treatment methods

Bulbar palsy and pseudobulbar syndromes are diagnosed using the following methods:

• General urine and blood tests.
• Electromyogram is a study of nerve conduction in the muscles of the face and neck.
• Tomography of the brain.
• Examination by an ophthalmologist.
• Esophagoscopy is an examination of the esophagus with a probe and a video camera.
• Analysis of cerebrospinal fluid - brain fluid.
• Tests for myasthenia gravis is an autoimmune disease characterized by extreme fatigue of striated muscles. Autoimmune diseases are disorders in which one’s own enraged immune system begins to kill.

Treatment methods and the possibility of complete recovery from bulbar or pseudobulbar palsy depend on the exact cause of their occurrence, since it is a consequence of other diseases. Sometimes it is possible to restore completely all functions, for example, if the disease was not caused by complete damage, but only by irritation of the brain due to infection, but more often during treatment the main goal is to restore vital functions: breathing, heartbeat and the ability to digest food, and it is also possible smooth out the symptoms somewhat.

Bulbar palsy is a syndrome of unilateral or bilateral damage to the 9, 10, 12 pairs of cranial nerves (glossopharyngeal, vagus, sublingual), the causes lie in damage to the medulla oblongata, sometimes they cannot be identified.

The syndrome is accompanied by a decrease in motor activity of muscle groups.

Concomitant diseases

Bulbar palsy is observed both in combination and independently in such diseases as:

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To correctly diagnose Guillain-Barré syndrome, it is necessary to pay attention to the clinical picture of the disease, which is characterized by:

1. nonspecific infection preceding the first signs of the disease;
2. lack of clear age limits - can develop at any age;
3. the onset of development is indicated by paresthesia and pain;
4. first, paresis develops in the proximal parts, then rapidly and symmetrically spreads further;
5. deep reflexes disappear in the affected muscle groups;
6. motor disorders are more pronounced than sensory ones;
7. spread of abnormalities to the cranial nerves;
8. increased protein concentration in the cerebrospinal fluid with a normal increase in cell number;
9. gradual restoration of motor functions;
10. absence of recurrent manifestations of the disease.

Symptoms

• Impaired swallowing function due to disruption of the muscles that regulate this process, which leads to difficulty swallowing. Disorders of the muscles of the tongue, soft palate, larynx, pharynx, and epiglottis are detected. This is accompanied by aphagia - the inability to swallow. In this case, liquids enter the nasal cavity, and solid food enters the larynx. The condition is accompanied by strong secretion of saliva. Food can enter the trachea or lungs, which can cause aspiration pneumonia and be fatal.
• Speech disorder up to the loss of the ability to speak. Speech becomes inaccessible to perception, and the voice may disappear.
• Rapid onset of fatigue when speaking.

There is a violation of pronunciation - dysarthria, and the development of complete muscle paralysis is possible. The patient hears and understands what others are saying, but cannot respond.

Bulbar syndrome affects the condition of other organs and systems, especially the respiratory and cardiovascular, which is due to their close location in relation to the damaged areas of the nerves.

Treatment

The effectiveness of treatment of manifestations of bulbar syndrome depends on the success of treatment of the underlying disease that caused it.

The essence of therapy is to restore impaired functions and maintain the overall vitality of the body. For this purpose, it is recommended to take vitamins, ATP (adenosine triphosphate - a compound involved in the exchange of energy and substances in the body), Proserin.

To normalize respiratory functions, artificial ventilation is used. To reduce salivary secretion, Atropine is taken, since in patients the volume of salivary gland secretions can reach up to 1 liter. However, all therapeutic measures may not lead to a complete recovery, but only improve the general condition.

What is the difference between bulbar palsy and pseudobulbar palsy?

Pseudobulbar palsy is a centralized paresis of muscles, the functioning of which is regulated by the work of bulbar nerve fibers.

If with bulbar palsy there is unilateral or bilateral damage to the nerves, then with pseudobulbar palsy there is complete destruction of the nuclear pathways from the cortical centers to the fiber nuclei.

It is accompanied by dysfunction of the muscles of the pharynx, vocal cords, and articulation disorder.

The main symptoms are similar to those of bulbar palsy:

• dysphagia;
• dysphonia or aphonia;
• dysarthyria.

The main difference is the absence of atrophic processes of the lingual muscles and defibrillar reflexes.

With pseudobulbar syndrome, uniform paresis of the facial muscles is observed, manifested in a violation of their movements. This is combined with an increase in reflexes of the lower jaw and chin.

The muscles of the lips, pharynx, and soft palate do not atrophy, unlike the condition with bulbar syndrome.

The changes do not affect the functioning of the respiratory and cardiovascular systems, which is due to a slightly different localization of pathological processes. There are no disturbances in vital functions, which is also a difference from the symptoms of bulbar palsy.

Reflexes

The hallmark of bulbar syndrome is uncontrollable laughter or crying when holding something over your exposed teeth (such as a piece of paper).

Pseudobulbar syndrome is characterized by manifestations of the following reflexes:

In addition to these symptoms, a number of others arise that are associated with multiple lesions in areas of the brain. There is a decrease in motor activity, memory deterioration, concentration, and loss of intelligence. Due to the resulting paresis, the face becomes motionless.

Accompanying illnesses

Pseudobulbar palsy develops against the background of:

• significant circulatory disorders of both hemispheres of the brain;
• atherosclerosis of cerebral vessels;
• motor neuron diseases;
• tumors of some parts of the brain;

During treatment, Proserin is often prescribed to relieve symptoms. It is imperative to use drugs whose action is aimed at improving blood clotting and accelerating metabolic processes.