Medications at the onset of bulbar paralysis, swallowing disorder. Bulbar syndrome: what is it? Bulbar palsy in children

Bulbar syndrome is a neurological pathology caused by dysfunction of three pairs of cranial nerves simultaneously: IX, X and XII. A disorder of the motor innervation of the muscles of the head and neck is manifested by a violation of the swallowing process, throwing food into the respiratory organs, speech deviations, hoarseness of the voice, a pathological change in taste sensations and vegetative symptoms.

Bulbar syndrome is characterized by blocking of nerve impulses at the level of cranial nuclei or motor fibers. A mild form of pathology develops with unilateral damage to the IX, X and XII nerves. Bilateral damage to the same nerves leads to the development of a severe degree of the disease.

Bulbar syndrome, in contrast, has a more severe course and is manifested by life-threatening dysfunctions: arrhythmia, atrophy of paralyzed muscles and respiratory arrest. The triad of symptoms is characteristic: dysphonia, dysphagia, dysarthria. Some patients are not even able to eat on their own. Diagnosis of the syndrome is based on the patient's examination data and the results of additional examinations. Usually, treatment begins with urgent measures, and then proceeds to etiotropic, pathogenetic and symptomatic therapy.

Bulbar syndrome is a severe progressive process that leads to disability and deterioration in the quality of life. The syndrome that quickly appeared with a rapid increase in clinical symptoms is deadly and requires emergency medical care and hospitalization of patients in the intensive care unit.

Classification

Bulbar syndrome is acute, progressive, alternating with one- or two-sided nature of the lesion.

Acute paralysis is characterized by a sudden onset and rapid development. Its main causes are strokes, encephalitis and neuroinfections.
Progressive paralysis is a less critical condition, characterized by a gradual increase in clinical symptoms. It develops in chronic degenerative diseases of the nervous system.
Alternating syndrome - damage to the nuclei of the bulbar zone with unilateral damage to the muscles of the body.

Etiology

The etiopathogenetic factors of paralysis are very diverse: impaired blood supply to the brain, TBI, acute infections, neoplasms, swelling of the brain tissue, inflammation, exposure to neurotoxins.

Bulbar syndrome is a manifestation of various mental and somatic diseases, which by origin can be divided into the following groups:

genetic - acute intermittent porphyria, Kennedy's disease, Chiari anomaly, paroxysmal myoplegia;
vascular - ischemic and hemorrhagic stroke of the brain, hypertensive crisis, thrombosis of the venous sinuses, dyscirculatory encephalopathy;
degenerative - syringobulbia, Guillain-Barré syndrome, myasthenia gravis, dystrophic myotonia, Alzheimer's disease;
infectious - encephalitis, tick-borne borreliosis, poliomyelitis, neurosyphilis, Lyme disease, diphtheria polyneuropathy, botulism, meningitis, encephalitis;
oncological - tumors of the cerebellum, gliomas, ependymomas, tuberculomas, cysts;
demyelinating - multiple sclerosis;
endocrine - hyperthyroidism;
traumatic - fractures of the base of the skull.

Factors provoking the development of the syndrome:

salty food abuse
frequent inclusion in the diet of high-carbohydrate and fatty foods and dishes,
chronic stress, frequent conflict situations,
excessive physical stress.

Pathogenesis

Electrical impulses from the brain enter the cortex, and then to the motor nuclei of the bulbar zone. Nerve fibers begin from them, along which signals are sent to the skeletal muscles of the upper body. The centers of the medulla oblongata in healthy people are responsible for hearing, facial expressions, swallowing and sound pronunciation. All cranial nerves are structural components of the CNS.

The vagus nerve has many branches that cover the entire body. The tenth pair of nerves starts from the bulbar nuclei and reaches the abdominal organs. Thanks to its proper work, the respiratory organs, stomach, and heart function at an optimal level. The vagus nerve provides swallowing, coughing, vomiting, and speech.
The glossopharyngeal nerve innervates the muscles of the pharynx and the parotid salivary gland, providing its secretory function.
The hypoglossal nerve innervates the muscles of the tongue and provides for swallowing, chewing, sucking and licking.

Under the influence of the etiological factor, the synaptic transmission of nerve impulses is disrupted and the nuclei of the IX, X and XII pairs of cranial nerves are simultaneously destroyed.

The etiopathogenetic factor can exert its negative impact on one of three levels:

in the nuclei of the medulla oblongata,
in the roots and trunks inside the cranial cavity,
in fully formed nerve fibers outside the cranial cavity.

As a result of damage to the nuclei and fibers of these nerves, the trophism of muscle tissue is disrupted. Muscles decrease in volume, become thinner, their number is reduced to complete disappearance. Bulbar paralysis is accompanied by hypo- or areflexia, hypo- or atony, hypo- or atrophy of paralyzed muscles. When the nerves innervating the respiratory muscles are involved in the process, patients die from suffocation.

Symptoms

The clinic of the syndrome is due to a violation of the innervation of the muscles of the throat and tongue, as well as dysfunction of these organs. Patients develop a specific symptom complex - dysphagia, dysarthria, dysphonia.

Swallowing disorder is manifested by frequent choking, salivation from the corners of the mouth, inability to swallow even liquid food.
Bulbar dysarthria and dysphonia are characterized by a weak and muffled voice, nasality and "blurring" of sounds. Consonant sounds become the same type, vowels become difficult to distinguish from each other, speech becomes slow, tedious, slurred, impossible. Nasal and slurred speech is associated with the immobility of the soft palate.
The voice of patients becomes weak, deaf, dwindling up to complete aphonia - a violation of the sound of speech. The reason for the changed voice timbre is the incomplete closure of the glottis, due to paresis of the laryngeal muscles.
Violations of mimic activity or its complete absence. Mimic functions lose their specificity, there is a general weakening of them, a violation of normal coordination. The facial features of the patient become inexpressive - the mouth is half open, profuse salivation and loss of chewed food.
Decrease and gradual extinction of the palatine and pharyngeal reflexes.
Weakness of the masticatory muscles due to paralysis of the corresponding nerves. Violation of the full chewing of food.
Atrophy of the muscles of the tongue and its immobility.
Entry of liquid and solid food into the nasopharynx.
Twitching of the tongue and drooping of the veil of the palate.
In severe cases - a violation of the heart, vascular tone, respiratory rhythm.

When examining patients, specialists detect a deviation of the tongue towards the lesion, its hypotension and immobility, and single fasciculations. In severe cases, glossoplegia is noted, which sooner or later ends with pathological thinning or folding of the tongue. Immobility and weakness of the palatine arches, uvula, and pharyngeal muscles lead to dysphagia. The constant reflux of food into the respiratory tract can result in aspiration and the development of inflammation. Violation of the autonomic innervation of the salivary glands is manifested by hypersalivation and requires constant use of a handkerchief.

In newborns, bulbar syndrome is a manifestation of cerebral palsy due to birth trauma. Babies have motor and sensory disorders, the sucking process is disturbed, they often burp. In children older than 2 years, the symptoms of the pathology are similar to those in adults.

Diagnostics

Diagnosis and treatment of bulbar palsy are carried out by specialists in the field of neurology. Diagnostic measures are aimed at identifying the immediate cause of the pathology and consist in examining the patient, identifying all the symptoms of the disease and conducting electromyography. The obtained clinical data and research results allow to determine the severity of paralysis and prescribe treatment. These are mandatory diagnostic methods, which are supplemented by a general blood and urine test, brain tomography, esophagoscopy, cerebrospinal fluid examination, electrocardiography, and an ophthalmologist's consultation.

During the first neurological examination, the patient's neurological status is determined: intelligibility of speech, voice timbre, salivation, swallowing reflex. Be sure to study the appearance of the tongue, identify atrophy and fasciculations, evaluate its mobility. An important diagnostic value is the assessment of respiratory rate and heart rate.

Then the patient is sent for additional diagnostic examination.

Using a laryngoscope, the larynx is examined and sagging of the vocal cord is found on the side of the lesion.
X-ray of the skull - determination of the structure of bones, the presence of fractures, injuries, neoplasms, foci of hemorrhage.
Electromyography is a research method that evaluates the bioelectric activity of muscles and allows you to determine the peripheral nature of paralysis.
Computed tomography - the most accurate images of any part of the body and internal organs, made using x-rays.
Esophagoscopy - determination of the work of the muscles of the pharynx and vocal cords by examining their inner surface using an esophagoscope.
Electrocardiography is the simplest, most accessible and informative method for diagnosing heart diseases.
MRI - layered images of any area of the body, allowing the most accurate study of the structure of a particular organ.
In laboratory tests, there are characteristic changes: in the cerebrospinal fluid - signs of infection or hemorrhage, in the hemogram - inflammation, in the immunogram - specific antibodies.

Treatment

Emergency medical care should be provided in full to patients with acute bulbar syndrome, accompanied by signs of respiratory and cardiovascular dysfunction. Resuscitation measures are aimed at maintaining the vital functions of the body.

Patients are connected to a ventilator or their trachea is intubated;
"Prozerin" is introduced, which restores muscle activity, improves the swallowing reflex and gastric motility, and slows down the pulse;
"Atropine" eliminates hypersalivation;
Antibiotics are administered with obvious signs of an infectious process in the brain;
Diuretics allow you to cope with cerebral edema;
Drugs that improve cerebral circulation are indicated in the presence of vascular disorders;
Patients with impaired breathing and heart activity are hospitalized in the intensive care unit.

The main goal of therapeutic measures is to eliminate the threat to the life of the patient. All patients with severe neurological disorders are transported to a medical facility, where they are given adequate treatment.

Stages of therapy:

Etiotropic therapy - the elimination of diseases that have become the root cause of the bulbar syndrome. In most cases, these ailments are not treated and progress throughout life. If an infection becomes the cause of the pathology, they take broad-spectrum antibacterial agents - Ceftriaxone, Azithromycin, Clarithromycin.
Pathogenetic treatment: anti-inflammatory - glucocorticoids "Prednisolone", decongestant - diuretics "Furosemide", metabolic - "Cortexin", "Actovegin", nootropic - "Mexidol", "Piracetam", antitumor - cytostatics "Methotrexate".
Symptomatic therapy is aimed at improving the general condition of patients and reducing the severity of clinical manifestations. B vitamins and preparations with glutamic acid stimulate metabolic processes in the nervous tissue. In severe dysphagia - the introduction of vasodilators and antispasmodics, infusion therapy, correction of vascular disorders. "Neostigmine" and "ATP" reduce the severity of diasphagia.
Currently, the use of stem cells, which are actively functioning instead of the affected ones, has a good therapeutic effect.
Patients with bulbar syndrome in severe cases are fed through an enteral tube with special mixtures. Relatives should monitor the condition of the oral cavity and observe the patient during meals to prevent aspiration.

The bulbar syndrome hardly gives in even to adequate therapy. Recovery occurs in isolated cases. In the process of treatment, the condition of patients improves, paralysis weakens, muscle work is restored.

Physiotherapeutic methods used to treat bulbar syndrome:

electrophoresis, laser therapy, magnetotherapy and mud therapy,
therapeutic massage to develop muscles and speed up the process of their recovery,
kinesitherapy - performing certain exercises that help restore the work of the human musculoskeletal system,
breathing exercises - a system of exercises aimed at strengthening health and developing the lungs,
physiotherapy exercises - certain exercises that accelerate recovery,
in the recovery period, classes with a speech therapist are shown.

Surgical intervention is resorted to in cases where conservative treatment does not give positive results. Operations are performed in the presence of tumors and fractures:

Shunt operations prevent the development of dislocation syndrome.
Craniotomy is performed in patients with epidural and subdural hematomas of the brain.
Clipping of pathologically dilated cerebral vessels is a surgical method that effectively eliminates abnormal changes in the circulatory system.
Cholesterol plaques are removed by endarterectomy and prosthesis of the damaged area.
In case of skull fractures, the skull is opened, the source of bleeding and bone fragments are eliminated, the bone tissue defect is closed with a removed bone or a special plate, and then they proceed to long-term rehabilitation.

Traditional medicine used to treat paralysis: infusions and decoctions of medicinal herbs, peony alcohol tincture, strong sage solution - medicines that strengthen the nervous system and relieve tension. Patients are recommended to take healing baths with a decoction of sage or wild rose.

Prevention and prognosis

Preventive measures to prevent the development of bulbar syndrome:

immunization by vaccination against major infectious diseases,
fight against atherosclerosis
control of blood pressure and blood sugar levels,
timely detection of neoplasms,
balanced diet with restriction of carbohydrates and fats,
playing sports and leading a mobile lifestyle,
observance of the regime of work and rest,
passing medical examinations with doctors,
the fight against smoking and alcohol consumption,
complete sleep.

The prognosis of the pathology is determined by the course of the underlying disease, which has become the root cause of the syndrome. The defeat of the nuclei of infectious etiology is completely cured, and the processes of swallowing and speech are gradually restored. Acute cerebrovascular accident, manifested by the clinic of the syndrome, in 50% of cases has an unfavorable prognosis. With degenerative pathologies and chronic ailments of the nervous system, paralysis progresses. Patients usually die of cardiopulmonary failure.

Video: bulbar syndrome - clinical options and physiotherapy treatment

Such a problem as the development of pseudobulbar syndrome in a child is a real test for parents. The fact is that the symptoms of this disease manifest themselves quite clearly and, with an untimely reaction, are overcome for a long time.

What is pseudobulbar syndrome

The essence of this disease is reduced to the appearance of multiple large and small foci of hemorrhage, which lead to damage on both hemispheres of the fibers that connect the motor nuclei of the cerebral cortex with the brain stem.

This type of lesion may develop due to recurrent strokes. But there are cases when pseudobulbar syndrome (PS) makes itself felt without previous cases of hemorrhage.

With such a problem, as a rule, bulbar functions begin to suffer. These are swallowing, chewing, articulation and phonation. Violation of such functions leads to such pathologies as dysphagia, dysphonia, dysarthria. The main difference between this syndrome and the bulbar syndrome is that there is no development of muscle atrophy and reflexes of oral automatism are observed:

Increased proboscis reflex;

Oppenheim reflex;

Nasolabial reflex of Astvatsaturov;

Distant-arial and other similar reflexes.

Pseudobulbar syndrome - causes

The development of this syndrome is a consequence of atherosclerosis of the cerebral vessels and the resulting softening foci, which can be localized in both hemispheres.

But this is not the only factor leading to such a syndrome. The vascular form of syphilis of the brain, as well as neuroinfections, degenerative processes, infections and tumors that affect both hemispheres, can also have a negative impact.

In fact, pseudobulbar syndrome occurs when, against the background of any disease, the central pathways leading from the motor centers of the cerebral cortex to the motor nuclei of the medulla oblongata are interrupted.

Pathogenesis

The development of such a syndrome is manifested by severe atheromatosis of the arteries of the base of the brain, which affects both hemispheres. In childhood, a bilateral lesion of the corticobulbar conductors is fixed, resulting in cerebral palsy.

If you have to deal with the pyramidal form of pseudobulbar syndrome, then the tendon reflex increases. In the extrapyramidal form, slow movements, stiffness, anemia and increased muscle tone are first recorded. The mixed form implies the total manifestation of the above symptoms, indicating a pseudobulbar syndrome. Photos of people affected by this syndrome confirm the seriousness of the disease.

Symptoms

One of the main symptoms of this disease is a violation of swallowing and chewing. In this state, food begins to get stuck on the gums and behind the teeth, liquid food can flow out through the nose, and the patient often chokes during the meal. Moreover, there are changes in the voice - it acquires a new shade. The sound becomes hoarse, consonants fall out, and some intonations are completely lost. Sometimes patients lose the ability to speak in a whisper.

With a problem such as pseudobulbar syndrome, symptoms can also be expressed through bilateral paresis of the facial muscles. This means that the face takes on a mask-like anemic appearance. It is also possible to manifest attacks of violent convulsive laughter or crying. But these symptoms are not always present.

It is worth mentioning the tendon reflex of the lower jaw, which in the process of developing the syndrome can increase dramatically.

Often pseudobulbar syndrome is fixed in parallel with a disease such as hemiparesis. Possible manifestation of extrapyramidal syndrome, which leads to stiffness, increased muscle tone and slowness of movement. Intellectual impairments are not excluded, which can be explained by the presence of multiple foci of softening in the brain.

At the same time, unlike the bulbar form, this syndrome excludes the occurrence of disorders of the cardiovascular and respiratory systems. This is due to the fact that pathological processes do not affect the vital centers, but develop in the medulla oblongata.

The syndrome itself can have both a gradual onset and an acute development. But if we consider the most common indicators, then it can be argued that in the vast majority of cases, the appearance of pseudobulbar syndrome is preceded by two or more attacks of cerebrovascular accident.

Diagnostics

To determine the pseudobulbar syndrome in children, it is necessary to differentiate its symptoms from nephritis, parkinsonism, bulbar palsy and nerves. One of the distinguishing features of the pseudoform will be the absence of atrophy.

It is worth noting that in some cases it can be quite difficult to distinguish PS from Parkinson's palsy. Such a disease proceeds slowly, and in the later stages apoplectic strokes are recorded. Moreover, signs similar to the syndrome appear: violent crying, speech disorder, etc. Therefore, a qualified doctor should determine the patient's condition.

The development of the syndrome in children

A problem such as pseudobulbar syndrome in newborns can manifest itself quite clearly. Already in the first month of life, signs of such a disease become noticeable.

When examining a baby with pseudobulbar syndrome, fibrillation and atrophy are not detected, but a reflex of oral automatism is recorded. Also, a similar syndrome can lead to the appearance of pathological crying and laughter.

Sometimes doctors diagnose combined forms of pseudobulbar and bulbar syndrome. This form of the disease is a consequence of amyotrophic lateral sclerosis, thrombosis in the system of vertebrobasilar arteries, inoperable malignant tumors of the trunk or demyelinating processes.

Treatment of the syndrome

In order to influence the pseudobulbar syndrome in children, one must initially take into account the stage of its course. In any case, the treatment will be more effective the sooner the parents take the child to the doctor.

In the event that this syndrome progresses, agents are usually used that are focused on normalizing lipid metabolism, coagulation processes and lowering cholesterol in the blood. Useful will be drugs that improve microcirculation, bioenergetics of neurons and metabolic processes in the brain.

A similar effect is exerted by drugs such as Encephabol, Aminalon, Cerebrolysin, etc. In some cases, doctors may prescribe drugs that have anticholinesterase effects (Prozerin, Oksazil).

Considering what disorders pseudobulbar syndrome causes in children, it is extremely important to know the signs indicating its development. After all, if you ignore the obvious symptoms and do not start the treatment process on time, then it may not be possible to completely neutralize the disease. This means that the child will suffer from swallowing disorders for the rest of his life, and not only.

But if you respond in a timely manner, then the chances of recovery will be quite high. Especially if stem cells are used in the treatment process. Their administration in a disease such as pseudobulbar syndrome can have the effect of physically replacing the myelin sheath and, moreover, restore the functions of cells that have been damaged. Such a restorative effect is able to return the patient to a full life.

How to influence the condition in newly born children

If pseudobulbar syndrome has been diagnosed in newborns, treatment will involve an integrated approach. First of all, this is a massage of the circular muscle of the mouth, feeding through a probe and electrophoresis with prozerin on the cervical spine.

Speaking about the first signs of recovery, it is worth noting that they include the appearance of newborn reflexes, which were absent before, stabilization of the neurological status and positive changes in the deviations recorded earlier. Also, with successful treatment, there should be an increase in motor activity against the background of hypodynamia or an increase in muscle tone in case of severe hypotension. In children with long gestational ages, a meaningful reaction to contact and emotional tone improves.

Recovery period in the treatment of newborns

In most cases, unless you have to deal with untreated severe lesions, the early recovery period begins within the first 2-3 weeks of a child's life. When dealing with a problem such as pseudobulbar syndrome, treatment at week 4 and beyond includes a recovery period therapy.

At the same time, for children who had to undergo convulsions, drugs are selected more carefully. Cortexin is often used, the course of which is 10 injections. In addition to these measures, Pantogam and Nootropil are orally administered to children during treatment.

Massage and physiotherapy

Regarding the use of massage, it is worth noting that it has a predominantly tonic and, in rare cases, relaxing effect. It is also held for all children. For those newborns who have spasticity of the limbs, massage is indicated earlier - on the 10th day of life. But it is important not to exceed the current norm - 15 sessions. In this case, this method of treatment is combined with the adoption of "Mydocalm" (twice a day).

Physiotherapy, in turn, is focused on electrophoresis of magnesium sulfate with aloe or lidase on the cervical spine.

Pseudobulbar dysarthia

This is one of the diseases that are the result of pseudobulbar syndrome. Its essence is reduced to a violation of the pathways connecting the nuclei of the bulbar group with the cerebral cortex.

This disease can have three degrees:

- Light. Violations are minor and manifest themselves in the fact that children do not pronounce growling and hissing sounds well. While writing the text, the child sometimes confuses the letters.

- Medium. Occurs more often than others. In this case, there is actually a complete absence of mimic movements. Children have difficulty chewing and swallowing food. At the same time, the tongue also moves poorly. In this state, the child cannot speak clearly.

- Severe degree (anarthria). Mimic movements are completely absent, as well as the mobility of the muscles of the speech apparatus. In such children, the lower jaw sags, while the tongue remains motionless.

With this disease, medical treatment methods, massage and reflexology are used.

It is easy to conclude that this syndrome is a fairly serious threat to the health of the child, so the disease requires parents to quickly respond to symptoms and patience in the treatment process.

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

The mechanism of the pathological condition is based on a violation of the activity of nerve cells located in the medulla oblongata. Despite the fact that the problem significantly reduces the quality of life of a person, 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 disturbed, 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.

Origin mechanism

If the main parts of the nervous system are damaged, human vital activity 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 violations.

The coordinated activity of different muscle groups is possible only with the most accurate coordination in the work of various parts of the brain. Autonomous functioning of subcortical structures cannot provide this.

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

The absence of a "manager" activates the work of the nuclei in offline mode.

Such isolated activity has the following consequences:

full preservation of the work of vital body systems (cardiovascular and respiratory);
paralysis of the soft palate leads to a violation of the act of swallowing;
speech becomes slurred;
inactivity of the vocal cords and impaired phonation.

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

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

The reasons

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 such a disorder may be the following conditions:

hypertension (high blood pressure), conducive to development;
the presence of atherosclerotic plaques in the arterioles of the brain;
circulatory disorders caused by unilateral damage to the blood vessels that feed the brain;
craniocerebral injuries of a diverse nature;
vasculitis caused by diseases such as tuberculosis or syphilis;
brain injury during childbirth;
metabolic disorders with prolonged use of drugs containing valproic acid;
malignant neoplasms and benign tumors in the frontal lobes or subcortical structures;
inflammation of brain tissues 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 the 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 will.

The process of swallowing, articulation is disturbed, 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 perspiration and the appearance of minor pauses. There is no atrophy and twitching of the affected muscles.

Damage to the cranial nerves is often manifested by a violation of speech, and only pronunciation suffers. Fuzzy articulation is combined with a deaf voice.

The appearance of violent laughter or involuntary crying is caused by a short-term spasm of the muscles of the face. Such behavior is absolutely not connected with the transferred emotional impressions and is carried out involuntarily.

Often there are symptoms indicating a violation of voluntary movements of the mimic 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 a separate disease. Such a disorder is mainly accompanied by some other neurological disorders.

The clinical picture and the degree of its severity are largely due to the main cause that activated the pathology. If the frontal lobes are affected, then the syndrome is manifested by symptoms of an emotional-volitional disorder. The patient may experience apathy, loss of interest in what is happening around, weak activity or lack of initiative.

Violations of motor functions are manifested if the elements of the subcortical zone are damaged. The main task of doctors is the correct differentiation of a relatively harmless pseudobulbar syndrome from a life-threatening bulbar disease.

Bulbar violation

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 are actively involved in regulating the coordination of movements, the formation of emotions and other vital functions.

Violations can develop for the following reasons:

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

The defeat of the nuclei leads to the development of a pathological condition, a 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 a short twitching in time;
difficult to distinguish speech;
weakening or complete loss of voice during a conversation.

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

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

In the respiratory movements, a failure occurs with the appearance of pauses in the process of breathing.

Treatment

Upon detection of a pseudobulbar syndrome, 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, prescribe therapy aimed at reducing pressure and normalizing the functioning of the cardiovascular system.

Antibacterial drugs are effective for vasculitis against or.

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

There is no classical treatment regimen for pseudobulbar syndrome today.

The therapeutic course is compiled on the basis of 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 appeared.

Bulbar and pseudobulbar syndromes have a lot in common with each other. They are rightfully serious pathologies of the nervous system.

With damage to the structural elements of the brain, the risk of violations of the functioning of vital systems and organs increases significantly.

Causes of the disease

There are several causes of bulbar paralysis, in particular:

Genetic.
Degenerative.
Infectious.

As a rule, bulbar palsy and pseudobulbar palsy develop as a result of a particular disease, and depending on this, the above division occurs. For example, Kennedy's amiatrophy is a genetic disease as a result of which this ailment manifests itself.

What does a skewed tongue look like with paralysis

In turn, diseases such as Gaye Barre syndrome, Lyme disease or polio act as a degenerative cause.

In addition, Bulbar paresis and paralysis can develop as a result of amyotrophic lateral sclerosis, botulism, syringobulbia, meningitis and encephalitis.

Important! People who have had to deal with such a phenomenon as ischemic stroke (a transient violation of cerebral circulation) are at risk of acquiring bulbar infectious paralysis.

Symptoms

The symptoms of bulbar paralysis are quite specific, and unlike the pseudobulbar type of the disease, they can lead to cardiac or respiratory arrest.

The main symptom of this disease is the difficulty of the swallowing reflex, which can lead to increased uncontrolled salivation in the patient.

In addition, the disease is characterized by:

violation of speech functions;
difficulty chewing food;
twitching of the tongue, in case of its paralysis;
protrusion of the tongue located in the throat in the direction opposite to paralysis;
sagging of the upper palate;
violation of phonation;

Phonation - the use of the larynx to produce sounds

arrhythmia;
violation of the respiratory and cardiac functions of the body.

Infectious bulbar paralysis is similar to pseudobulbar paralysis in many symptoms, however, in the second type of the disease, cardiac and respiratory arrest is not observed. Also, there was no twitching of the tongue with its paralysis.

Disease in childhood

If with adults everything is more or less clear, then with young children not everything is as simple as it seems.

So, in young children it is difficult to diagnose the disease by the main symptom - increased salivation as a result of a difficult swallowing reflex. Every 3 child has such a symptom, and not because there is a pathology, but because of the characteristics of the child's body.

How to recognize an illness in a child? To do this, you need to examine the baby's oral cavity and pay attention to the position of the tongue. If it is unnaturally shifted to the side or twitching is noted, it makes sense to contact a specialist for a thorough analysis.

In addition, these children have problems with swallowing food, it can fall out of the mouth or enter the nasopharynx when it comes to liquid.

In addition, a sick child may experience partial facial paralysis, which manifests itself in the absence of changes in the baby's facial expressions.

How to diagnose a disease?

The diagnosis of this disease does not include the presence of a huge number of tests and instrumental methods of treatment. The basis is an external examination of the patient by a specialist, as well as a procedure such as electromyography.

Electromyography is a study of bioelectric potentials that arise in human muscles during excitation of muscle fibers.

Based on the data obtained, the doctor makes a conclusion and prescribes treatment.

Treatment

As a rule, the treatment of bulbar paralysis is carried out in a hospital. However, it does not occur to a person to make an appointment with a surgeon in advance, and an appeal to a medical institution with symptoms characteristic of this disease occurs already in the later stages of the disease, which entails a threat to the patient's life.

For this reason, it is important to eliminate the threat to human life. In particular:

The patient may need to remove mucus from the throat, for artificial ventilation of the lungs. Only after the patient's life is not in danger, is it possible to transport him to a medical institution.

The hospital organizes treatment aimed at eliminating symptoms and directly to eliminate, in particular:

To resume the swallowing reflex, a person is prescribed Prozerin, Adenosine triphosphate and a vitamin complex

To eliminate uncontrolled salivation, the patient is shown Atropine

To eliminate symptomatic manifestations, drugs are prescribed that are characteristic of a particular symptom (for each person individually)

Although the mainstay of treatment is to eliminate the cause, this syndrome is difficult to treat, and since the nerve roots deep in the brain are usually affected, surgery is unlikely to correct the problem.

Nevertheless, thanks to modern methods of treatment, bulbar palsy is not a sentence, and it is possible to live normally with it, subject to supportive therapy. Therefore, when primary symptoms occur, it is better to once again contact a specialist and get good news than to drag out and hear an unpleasant diagnosis. Take care of yourself and your loved ones and do not self-medicate.

Medications at the onset of bulbar paralysis, swallowing disorder. Bulbar syndrome: what is it? Bulbar palsy in children

Classification

Etiology

Pathogenesis

Symptoms

Diagnostics

Treatment

Prevention and prognosis

Video: bulbar syndrome - clinical options and physiotherapy treatment

What is pseudobulbar syndrome

Pseudobulbar syndrome - causes

Pathogenesis

Symptoms

Diagnostics

The development of the syndrome in children

Treatment of the syndrome

How to influence the condition in newly born children

Recovery period in the treatment of newborns

Massage and physiotherapy

Pseudobulbar dysarthia

Origin mechanism

The reasons

Clinical symptoms

Bulbar violation

Treatment

Related videos

Causes of the disease

Symptoms

Disease in childhood

How to diagnose a disease?

Treatment