Initially, patients with progressive bulbar palsy only have muscle weakness that affects speech and swallowing. However, this condition can often progress to amyotrophic lateral sclerosis or ALS.
Definition. Bulbar weakness (or bulbar palsy) refers to bilateral impairment of function of the lower cranial nerves IX, X, XI and XII, which occurs due to lower motor neuron lesion either at nuclear or fascicular level in the medulla or from bilateral lesions of the lower cranial nerves outside the brain-stem.
Progressive bulbar palsy (PBP) PBP involves both upper and lower motor neurones and affects about a quarter of the patients diagnosed. This form of MND often causes difficulties with speech or swallowing.
Bulbar palsy is sometimes classified as progressive or non-progressive. Progressive bulbar palsy is more common and refers to the escalation of symptoms over time. It can occur in both children and adults.
Overview. A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII. A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII.
A bulbar palsy refers to disease affecting the glossopharyngeal, vagus, accessory and hypoglossal nerves and is due to lower motor neuron pathology. Typically, patients with a bulbar palsy present with signs and symptoms of the cranial nerves affected as mentioned.
Progressive bulbar palsy is a term reserved for involvement only of the bulbar muscles in MND. Some people can develop problems with the bulbar muscles first and then go on to develop problems in the arms or legs – this is a form of ALS rather than progressive bulbar palsy.
G12. 22 - Progressive bulbar palsy. ICD-10-CM.
Progressive bulbar palsy (PBP), also called progressive bulbar atrophy, attacks the lower motor neurons connected to the brain stem. The brain stem (also known as the bulbar region) controls the muscles needed for swallowing, speaking, chewing, and other functions.
Nerve conduction study showed demyelinating motor neuropathy. Based on typical clinical course and electrophysiological studies, the diagnosis was made. To the best of our knowledge, this is the first pediatric case of unilateral facial palsy with bulbar involvement without any motor abnormality.
Compared with typical bulbar onset amyotrophic lateral sclerosis (ALS), isolated bulbar palsy (IBP), an often under-understood variant of ALS, is characterized by symptoms confined to bulbar region for extended periods and relative preservation of limb and ventilation function.
Bulbar Palsy can be caused by any of the following conditions:Cerebrovascular – medullary infarction.Motor neuron disease.High brain stem tumors.Head injury.Toxin – Botulism.Neurosyphilis.Inflammatory – Guillain-Barré syndrome, Lyme disease.Subacute meningitis (carcinoma, lymphoma)
Bulbar weakness tends to give speech a slurred, nasal quality. It also can lead to frequent choking spells and make eating unpleasant and tiresome. Limb weakness alone is highly uncommon and can be seen in only 5% of MG patients. In some rare cases, weakness may spread to muscles in the chest that control breathing.
Although progression is variable by case, Bulbar Onset ALS tends to have a faster progression than Limb Onset cases. Early symptoms include slurred speech, difficulty chewing and swallowing, excessive choking and weakness or twitching in the muscles of the face, jaw, throat and voice box, particularly the tongue.
As there is no cure for Bulbar Palsy, treatment is essentially limited to medical management and support. For patients presenting with Bulbar Palsy, treatment will be directed to the underlying cause of the syndrome. Medication may include intravenous immunoglobulin (antibody) and steroids.
Definition of bulbar : of or relating to a bulb specifically : involving the medulla oblongata bulbar polio.