Bulbar palsy develops with damage to the cranial nerves. Appears with bilateral and to a lesser extent with a one-sided lesion of 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. In connection with the proximity of the location of the anatomical structures of the medulla oblongata, bulbar and pseudobulbar paralysis are infrequent.
Clinical picture
With bulbar syndrome, dysarthria and dysphagia are noted. Patients, as a rule, choke with liquid, in some cases they are not able to carry out swallowing movement. In conjunction with this, saliva in such patients often flows from the corners of the mouth.
With bulbar paralysis, atrophy of the muscles of the tongue begins and pharyngeal and palatine reflexes fall out. In seriously ill patients, as a rule, respiratory rhythm and cardiac work disorders are formed, which often leads to death. This is confirmed by the location of the centers of the respiratory and cardiovascular systems close to the nuclei of the caudal group of head nerves, in connection with which the latter can be involved in the painful process.
Causes
Factors of this disease are all sorts 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-Barré 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 paralysis signs have the following:
- Dysarthria Speech in patients becomes deaf, blurred, slurred, nasal, and sometimes aphonia (loss of sonority) can be observed.
- Dysphagia. Patients can not always make swallowing movements, so eating is difficult. Also in this regard, saliva often flows through the corners of the mouth. With advanced cases, swallowing and palatine reflexes can completely drop out.
Myasthenia gravis
Myasthenia gravis is manifested by the following symptoms:
- causeless fatigue of various muscle groups;
- double vision
- prolapse of the upper eyelid;
- weakness of facial muscles;
- decreased visual acuity.
Aspiration syndrome
Aspiration syndrome manifests itself:
- ineffective cough;
- difficulty breathing with involvement of the auxiliary muscles and wings of the nose in the act of breathing;
- difficulty breathing on inspiration;
- wheezing on exhalation.
Pathology of breathing
Respiratory failure is most often manifested:
- chest pain;
- rapid breathing and palpitations;
- shortness of breath
- coughing
- swelling of the cervical veins;
- blue skin;
- loss of consciousness;
- drop in blood pressure.
Cardiomyopathy is accompanied by shortness of breath with great physical exertion, chest pain, swelling of the lower extremities, dizziness.
Pseudobulbar palsy, in addition to dysarthria and dysphagia, is manifested by violent crying, sometimes laughter. Patients may cry when teeth are bared or without cause.
Difference
Differences are much smaller than similarities. First of all, the difference between bulbar and pseudobulbar palsy is the root cause of the disorder: bulbar syndrome is caused by trauma to the medulla oblongata and nerve nuclei located in it. Pseudobulbar - insensitivity of cortical-nuclear compounds.
Hence the differences in symptoms follow:
- bulbar paralysis is much more difficult and carries a great threat to life (stroke, infection, botulism);
- a reliable indicator of bulbar syndrome is a violation of breathing and the rhythm of the heartbeat;
- with pseudobulbar paralysis, there is no process of muscle reduction and recovery;
- pseudosyndrome is indicated by specific mouth movements (folding lips, unpredictable grimaces, whistles), illegible speech, decreased activity and degradation of intelligence.
Despite the fact that the other consequences of the disease are identical or very similar to each other, significant differences are observed in treatment methods. With bulbar paralysis, lung ventilation, Prozerin and Atropine are used, and with pseudobulbar paralysis, more attention is paid to blood circulation in the brain, lipid metabolism and lowering cholesterol.
Diagnostics
Bulbar and pseudobulbar paralysis are disorders of the central nervous system. They are very similar in symptoms, but have a completely different etiology of occurrence.
The main diagnosis of these pathologies is based primarily on the analysis of clinical manifestations, attention span on certain nuances (signs) in the symptoms that distinguish bulbar paralysis from pseudobulbar paralysis. This is important, because these ailments lead to different, different from each other, consequences for the body.
So, the following symptoms are common symptoms for both types of paralysis: impaired swallowing function (dysphagia), voice dysfunction, disorders and speech disorders.
The above similar symptoms have one significant difference, namely:
- with bulbar paralysis, these symptoms are the result of atrophy and muscle destruction;
- with pseudobulbar paralysis, these same symptoms are manifested due to paresis of the facial muscles of a spastic nature, while the reflexes are not only preserved, but also have a pathologically exaggerated character (which is expressed in violent excessive laughter, crying, there are signs of oral automatism).
Treatment
If damage occurs to areas of the brain, the patient may experience quite serious and hazardous pathological processes that significantly reduce the standard of living, and can also lead to death. Bulbar and pseudobulbar paralysis is a type of nervous system disorder whose symptoms differ in their etiology, but have similarities.
Bulbar develops as a result of improper functioning of the medulla oblongata, namely the nuclei of the sublingual, vagus and glossopharyngeal nerves that are in it. Pseudobulbar syndrome occurs due to impaired functioning of the cortical-nuclear pathways. After determining pseudobulbar palsy, initially you need to deal with the treatment of the underlying disease.
So, if the symptom is caused by hypertension, vascular and hypotensive therapy is usually prescribed. With tuberculosis and syphilitic vasculitis, antibiotics and antimicrobials are required. In this case, treatment can also be carried out by narrow specialists - a TB specialist or a dermatovenerologist.
In addition to specialized therapy, the patient is shown the appointment of medications that help improve microcirculation in the brain, normalize the functioning of nerve cells and improve the transmission of nerve impulses to it. To this end, anticholinesterase drugs, various nootropic, metabolic and vascular agents are prescribed. The main goal that treatment for bulbar syndrome is directed to is maintaining at a normal level important functions for the body. For the treatment of progressive bulbar palsy, the following is prescribed:
- eating using a probe;
- mechanical ventilation;
- “Atropine” in case of abundant salivation;
- "Proserin" to restore the swallowing reflex.
After the possible implementation of resuscitation measures, complex treatment is usually prescribed, affecting the underlying disease - primary or secondary. This helps to maintain and improve the quality of life, as well as significantly alleviate the condition of the patient.
There is no universal remedy that would effectively cure pseudobulbar syndrome. In any case, the doctor should choose a scheme of complex therapy, for which all existing violations are taken into account. Additionally, you can use physiotherapy, respiratory gymnastics according to Strelnikova, as well as exercises for poorly functioning muscles.
As practice shows, it is not possible to completely cure pseudobulbar paralysis, since such disorders develop as a result of severe brain lesions, moreover, bilateral ones. Often they can be accompanied by the destruction of nerve endings and the death of many neurons.
Treatment, however, makes it possible to compensate for disturbances in the functioning of the brain, and regular rehabilitation classes allow the patient to adapt to new problems. So, do not refuse the doctor's recommendations, as they help slow down the progression of the disease and put in order the nerve cells. Some experts recommend introducing stem cells into the body for effective treatment. But this is a rather debatable question: according to supporters, these cells contribute to the restoration of neuron functions, and physically replace mycelin. Opponents, however, believe that the effectiveness of this approach has not been proven, and can 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 is 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 complex way.
With improper and untimely treatment, bulbar paralysis can cause cardiac arrest and breathing. The prognosis depends on the course of the underlying disease or may even remain unclear.
Effects
Despite the similar symptoms and manifestations, bulbar and pseudobulbar disorders have different etiologies and, as a result, lead to different consequences for the body. With bulbar paralysis, the symptomatology manifests itself as a result of atrophy and degeneration of muscles, therefore, if urgent resuscitation measures are not taken, the consequences can be severe. In addition, when lesions affect the respiratory and cardiovascular parts of the brain, respiratory distress and heart failure can develop, which, in turn, is fatal.
Pseudobulbar paralysis does not have atrophic muscle lesions and has an antispasmodic character. Localization of pathologies is observed above the medulla oblongata, therefore there is no threat of respiratory arrest and cardiac impairment, there is no threat to life.
The main negative consequences of pseudobulbar paralysis include:
- unilateral paralysis of the muscles of the body;
- paresis of limbs.
In addition, due to the softening of certain parts of the brain, the patient may experience memory impairment, dementia, impaired motor function.