Bulbar syndrome, called bulbar palsy, is a syndrome of damage to the hyoid, glossopharyngeal and vagus cranial nerves, the nuclei of which are located in the medulla oblongata. Bulbar syndrome occurs with bilateral (less often with unilateral) damage to the nuclei of the X, IX, XI and XII cranial nerves, belonging to the caudal group and embedded in the medulla oblongata. In addition, roots and nerve trunks inside the cranial cavity and beyond are damaged.
With bulbar syndrome, peripheral paralysis of the muscles of the pharynx, lips, tongue, soft palate, epiglottis and vocal folds occurs. The result of such paralysis is dysphagia (impaired swallowing function) and dysarthria (impaired speech). Bulbar dysarthria is characterized by a weak and deaf voice, up to a complete aphonia, a nasal and "blurred" sound appears. The pronunciation of consonants that differ in the place of articulation (anterior lingual, labial, posterior lingual) and the method of formation (slotted, occlusive, soft, hard) becomes the same, and vowels are difficult to distinguish from each other. Speech in patients diagnosed with bulbar syndrome is slow and very tiresome for patients. Depending on the severity of muscle paresis and its prevalence, bulbar dysarthria syndrome can be global, partial or selective.
Patients with bulbar palsy are choked even with liquid food, because unable to produce swallowing movement, in severe cases, patients develop disorders of the heart and respiratory rhythms, which very often leads to death. Therefore, timely emergency care for patients with this syndrome is extremely important. It consists in eliminating the threat to life and then transporting it to a specialized medical institution.
Bulbar syndrome is characteristic of the following diseases:
- genetic diseases such as Kennedy’s disease and porphyria;
- vascular diseases (myocardial medulla oblongata);
- syringobulbia, motor neuron disease;
- inflammatory and infectious diseases (Lyme disease, Guillain-Barré syndrome);
- Oncological diseases (glioma of the brain stem).
The basis for the diagnosis of bulbar palsy is the identification of characteristic signs or clinical symptoms. The most reliable methods for diagnosing this disease include electromyography and a direct examination of the oropharynx.
There are bulbar and pseudobulbar syndromes. The main difference between them is that in pseudobulbar syndrome, paralyzed muscles do not become atrophied, i.e. paralysis is peripheral, there are no fibrillar twitches of the muscles of the tongue and the reaction of degeneration. Pseudobulbar palsy is often accompanied by violent crying and laughter, which are caused by a violation of the connections between the central subcortical nodes and the cortex. Pseudobulbar syndrome, unlike bulbar syndrome, does not cause apnea (respiratory arrest) and cardiac arrhythmias. It is observed mainly with diffuse brain lesions having a vascular, infectious, intoxication or traumatic genesis.
Bulbar Syndrome: treatment.
The treatment of bulbar paralysis is mainly aimed at eliminating the underlying disease and compensating for the functions that are impaired. To improve swallowing function, drugs such as glutamic acid, proserin, nootropic drugs, galantamine and vitamins are prescribed, and with increased salivation, the drug atropine. Feeding of such patients is carried out through a probe, i.e. enteral. If respiratory function is impaired, mechanical ventilation is prescribed.