Bulbar palsy develops when the cranial nerves are damaged. Appears with bilateral and to a lesser extent with unilateral lesions 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. Due to the proximity of the location of the anatomical structures of the medulla oblongata, bulbar and pseudobulbar paralysis are rare.
Clinical picture
Dysarthria and dysphagia are seen in bulbar syndrome. Patients, as a rule, choke on liquid, in some cases they are not able to carry out a swallowing movement. As a result, saliva often flows from the corners of the mouth in these patients.
When bulbar palsy begins atrophy of the muscles of the tongue and fall pharyngeal and palatine reflexes. In seriously ill patients, as a rule, disorders of the rhythm of breathing and cardiac work are formed, which often leads to death.exodus. This is confirmed by the close location of the centers of the respiratory and cardiovascular systems with the nuclei of the caudal group of the head nerves, and therefore the latter can be involved in the painful process.
Reasons
The factors of this disease are all kinds of ailments leading to damage to the 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 a standard symptom complex.
Symptoms
Bulbar and pseudobulbar paralysis has the following signs:
- Dysarthria. Speech in patients becomes deaf, blurry, slurred, nasal, and sometimes there may be aphonia (loss of sonority of the voice).
- Dysphagia. Patients cannot always make swallowing movements, so eating is difficult. Also in connection with this, saliva often flows out through the corners of the mouth. In advanced cases, the swallowing and palatal reflexes may completely disappear.
Myasthenia gravis
Myasthenia is manifested by the following symptoms:
- uncaused fatigue of various muscle groups;
- double vision;
- lowering the topcentury;
- weakness of facial muscles;
- decrease in visual acuity.
Aspiration syndrome
Aspiration syndrome manifests itself:
- ineffective cough;
- difficulty breathing with involvement of accessory muscles and wings of the nose in the act of breathing;
- difficulty breathing while inhaling;
- whistling wheezes on exhalation.
Respiratory pathologies
Respiratory failure most commonly seen:
- chest pain;
- rapid breathing and heartbeat;
- short of breath;
- cough;
- swollen neck veins;
- blue skin;
- passing out;
- lowering blood pressure.
Cardiomyopathy is accompanied by shortness of breath with great physical exertion, chest pain, swelling of the lower extremities, dizziness.
Pseudobulbar paralysis, in addition to dysarthria and dysphagia, is manifested by violent crying, sometimes laughter. Patients may cry when their teeth are bared or for no reason.
Distinction
The differences are much less 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 trauma to the medulla oblongata and the nerve nuclei in it. Pseudobulbar - insensitivity of cortical-nuclear connections.
Hence the differences in symptoms follow:
- bulbar palsy is much more severe and carriesa major threat to life (stroke, infection, botulism);
- a reliable indicator of bulbar syndrome - a violation of breathing and heart rhythm;
- with pseudobulbar palsy there is no process of muscle reduction and recovery;
- Pseudo-syndrome is indicated by specific mouth movements (pulling lips into a tube, unpredictable grimaces, whistling), slurred speech, reduced activity and degradation of intelligence.
Despite the fact that the rest of the consequences of the disease are identical or very similar to each other, there are significant differences in the methods of treatment. With bulbar paralysis, ventilation of the lungs, "Prozerin" and "Atropine" are used, and with pseudobulbar paralysis, more attention is paid to blood circulation in the brain, lipid metabolism and lowering cholesterol.
Diagnosis
Bulbar and pseudobulbar paralysis are disorders of the central nervous system. They are very similar in symptoms, but they have a completely different etiology of occurrence.
The main diagnosis of these pathologies is based primarily on the analysis of clinical manifestations, focusing on individual nuances (signs) in the symptoms that distinguish bulbar palsy from pseudobulbar palsy. This is important because these ailments lead to different, different consequences for the body.
So, common symptoms for both types of paralysis are the following manifestations: dysfunction of swallowing (dysphagia), voicedysfunction, disorders and speech disorders.
These similar symptoms have one significant difference, namely:
- with bulbar paralysis, these symptoms are the result of atrophy and muscle destruction;
- with pseudobulbar palsy, 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 character (which is expressed in violent excessive laughter, crying, there are signs of oral automatism).
Treatment
If there is a lesion of parts of the brain, the patient may experience quite serious and dangerous pathological processes that significantly reduce the standard of living, and can also lead to death. Bulbar and pseudobulbar palsy is a type of disorder of the nervous system, the symptoms of which differ in their etiology, but have similarities.
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 cortical-nuclear pathways. After determining pseudobulbar palsy, it is initially necessary to deal with the treatment of the underlying disease.
So, if the symptom is caused by hypertension, vascular and antihypertensive therapy is usually prescribed. With tuberculous and syphilitic vasculitis, antibiotics andantimicrobial agents. Treatment in this case can also be carried out by narrow specialists - a phthisiatrician or a dermatovenereologist.
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. For this purpose, anticholinesterase drugs, various nootropic, metabolic and vascular agents are prescribed. The main goal of treatment for bulbar syndrome is the maintenance of important functions for the body at a normal level. For the treatment of progressive bulbar palsy is prescribed:
- eating with a probe;
- artificial lung ventilation;
- "Atropine" in case of abundant salivation;
- "Prozerin" to restore the swallowing reflex.
After the possible implementation of resuscitation measures, a complex treatment is usually prescribed that affects the underlying disease - primary or secondary. This helps to maintain and improve the quality of life, as well as significantly alleviate the patient's condition.
There is no universal remedy that would effectively cure pseudobulbar syndrome. In any case, the doctor should select a complex therapy scheme, for which all existing violations are taken into account. Additionally, you can use physiotherapy, breathing exercises according to Strelnikova, as well as exercises for poorly functioning muscles.
As practice shows, completely curepseudobulbar paralysis fails, since such disorders develop as a result of severe brain damage, and bilateral. Often they can be accompanied by the destruction of nerve endings and the death of many neurons.
Treatment, on the other hand, 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, you should not refuse the doctor's recommendations, as they help slow down the progression of the disease and put nerve cells in order. Some experts recommend introducing stem cells into the body for effective treatment. But this is a rather debatable issue: according to supporters, these cells contribute to the restoration of neuronal functions, 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 complex way.
With improper and untimely treatment, 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 similarsymptoms and manifestations of bulbar and pseudobulbar disorders have different etiologies and, as a result, lead to different consequences for the body. With bulbar paralysis, the symptoms manifest themselves due to atrophy and degeneration of the muscles, 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 can develop, which, in turn, is fatal.
Pseudobulbar palsy does not have atrophic muscle lesions and has an antispasmodic character. Localization of pathologies is observed above the medulla oblongata, so there is no threat of respiratory arrest and cardiac dysfunction, there is no threat to life.
The main negative consequences of pseudobulbar palsy include:
- unilateral paralysis of body muscles;
- paresis of limbs.
In addition, due to the softening of certain parts of the brain, the patient may experience memory impairment, dementia, impaired motor functions.
