Bulbar disorders are characteristic of. Dangerous disease of the brain: bulbar syndrome. Treatment prognosis and possible complications

Bulbar syndrome (or bulbar paralysis) is a complex lesion of the IX, X and XII cranial nerves (vagus, glossopharyngeal and hypoglossal nerves), whose nuclei are located in the medulla oblongata. They innervate the muscles of the lips, soft palate, tongue, pharynx, larynx, as well as the vocal cords and epiglottal cartilage.

Symptoms

Bulbar palsy is a triad of three leading symptoms: dysphagia(swallowing disorder) dysarthria(violation of the correct pronunciation of articulate speech sounds) and aphonia(violation of the sonority of speech). A patient suffering from this paralysis cannot swallow solid food, and liquid food will enter the nose due to the paresis of the soft palate. The patient's speech will be incomprehensible with a hint of nasality (nazolium), this violation is especially noticeable when the patient pronounces words containing such complex sounds as "l" and "r".

To make a diagnosis, the doctor must conduct a study of the functions of the IX, X and XII pairs of cranial nerves. Diagnosis begins with finding out if the patient has problems swallowing solid and liquid food, whether he chokes on it. During the answer, the patient's speech is carefully listened to, violations characteristic of paralysis, noted above, are noted. Then the doctor examines the oral cavity, performs laryngoscopy (a method for examining the larynx). With unilateral bulbar syndrome, the tip of the tongue will be directed towards the lesion, or completely motionless with bilateral. The mucous membrane of the tongue will be thinned and folded - atrophic.

Examination of the soft palate will reveal its lag in pronunciation, as well as the deviation of the palatine uvula to the healthy side. Using a special spatula, the doctor checks the palatine and pharyngeal reflexes, irritating the mucous membrane of the soft palate and the posterior pharyngeal wall. The absence of vomiting, coughing movements indicate damage to the vagus and glossopharyngeal nerves. The study ends with laryngoscopy, which will help confirm the paralysis of the true vocal cords.

The danger of bulbar syndrome is vagus nerve injury. Lack of function of this nerve will cause abnormal heart rhythm and respiratory distress, which can immediately lead to death.

Etiology

Depending on the disease caused by bulbar palsy, there are two types of it: acute and progressive. Acute most often occurs due to acute circulatory disorders in the medulla oblongata (heart attack) due to thrombosis, vascular embolism, and also when the brain is wedged into the foramen magnum. Severe damage to the medulla oblongata leads to a violation of the vital functions of the body and the subsequent death of the patient.

Progressive bulbar palsy develops with amyotrophic lateral sclerosis. This rare disease is a degenerative change in the central nervous system that causes damage to motor neurons, causing muscle atrophy and paralysis. ALS is characterized by all the symptoms of bulbar paralysis: dysphagia when taking liquid and solid foods, glossoplegia and atrophy of the tongue, sagging of the soft palate. Unfortunately, there is no cure for amyotrophic sclerosis. Paralysis of the respiratory muscles causes the death of the patient due to the development of suffocation.

Bulbar paralysis often accompanies a disease such as myasthenia gravis. No wonder the second name of the disease is asthenic bulbar palsy. The pathogenesis consists in an autoimmune lesion of the body, causing pathological muscle fatigue.

In addition to bulbar lesions, muscle fatigue after exercise, which disappears after rest, joins the symptoms. The treatment of such patients consists in the appointment of anticholinesterase drugs by the doctor, most often Kalimin. The appointment of Prozerin is not advisable because of its short-term effect and a large number of side effects.

Differential Diagnosis

It is necessary to correctly differentiate bulbar syndrome from pseudobulbar palsy. Their manifestations are very similar, however, there is a significant difference. Pseudobulbar paralysis is characterized by reflexes of oral automatism (proboscis reflex, distance-oral and palmar-plantar reflex), the occurrence of which is associated with damage to the pyramidal tracts.

The proboscis reflex is detected when a neurological hammer is gently tapped on the upper and lower lip - the patient pulls them out. The same reaction can be traced when the hammer approaches the lips - a distance-oral reflex. Stroke irritation of the skin of the palm above the elevation of the thumb will be accompanied by a contraction of the mental muscle, causing the skin to pull up on the chin - palmo-chin reflex.

Treatment and prevention

First of all, the treatment of bulbar syndrome is aimed at eliminating the cause that caused it. Symptomatic therapy consists in the elimination of respiratory failure with a ventilator. To restore swallowing, a cholinesterase inhibitor is prescribed -. It blocks cholesterase, as a result of which the action of acetylcholine is enhanced, leading to the restoration of conduction along the neuromuscular fiber.

M-anticholinergic Atropine blocks M-cholinergic receptors, thereby eliminating increased salivation. Patients are fed through a tube. All other therapeutic measures will depend on the specific disease.

There is no specific prevention for this syndrome. To prevent the development of bulbar paralysis, it is necessary to treat diseases that can cause it in a timely manner.

Video on how exercise therapy is performed for bulbar syndrome:

Bulbar syndrome, called bulbar palsy, is a syndrome of damage to the hypoglossal, glossopharyngeal, and vagus cranial nerves, the nuclei of which are located in the medulla oblongata. Bulbar syndrome occurs with bilateral (rarely 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 and outside the cranial cavity 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 (speech impairment). characterized by a weak and deaf voice, up to complete aphonia, nasal and "blurred" sounds appear. The pronunciation of consonant sounds that differ in the place of articulation (front-lingual, labial, back-lingual) and in the method of formation (slit, stop, soft, hard) becomes the same type, and vowels become difficult to distinguish from each other. Speech in patients diagnosed with "bulbar syndrome" is slow and very tiring for patients. Depending on the severity of muscle paresis and its prevalence, the syndrome of bulbar dysarthria can be global, partial or selective.

Patients with bulbar palsy choke on even liquid food, because. unable to produce swallowing movements, in especially severe cases, patients develop disorders of cardiac activity 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 subsequent transportation to a specialized medical facility.

Bulbar syndrome is characteristic of the following diseases:

Genetic diseases such as Kennedy's disease and porphyria

Vascular diseases (infarction of the medulla oblongata);

Syringobulbia, motor neuron disease;

Inflammatory-infectious Lyme, Guillain-Barré syndrome);

Oncological diseases (brainstem glioma).

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 data and direct examination of the oropharynx.

There are bulbar and pseudobulbar syndromes. The main difference between them is that with pseudobulbar syndrome, paralyzed muscles do not become atrophied, i.e. the paralysis is peripheral, there are no fibrillar twitches of the muscles of the tongue and the reaction of degeneration. Pseudobulbar paralysis is often accompanied by violent crying and laughter, which are due to 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 in diffuse lesions of the brain, which have a vascular, infectious, intoxication or traumatic genesis.

Bulbar syndrome: treatment.

Treatment of bulbar paralysis is aimed mainly at eliminating the underlying disease and compensating for functions that are impaired. To improve the function of swallowing, drugs such as glutamic acid, prozerin, 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. enterally. In case of violation of the respiratory function, artificial ventilation of the lungs is prescribed.

Bulbar syndrome (another name for the disease is bulbar paralysis) is a pathology in which several cranial nerves are affected: vagus, glossopharyngeal, hypoglossal). The nuclei of these cells are located in the medulla oblongata in the so-called bulbar zone.

These nerves are responsible for the innervation of the lips, tongue, palate, larynx, vocal cords. The defeat of these nerves causes violations of speech, chewing and swallowing, taste sensitivity.

The causes of bulbar syndrome can be different: impaired blood flow in the medulla oblongata, damage to nerve fibers, trauma to the base of the skull, infectious diseases, tumors. Treatment of the syndrome depends on the causes of the disease.

In the treatment, folk remedies are used. Such therapy normalizes the nutrition of tissues and improves the overall health of a person.

Bulbar palsy develops when the cranial nerves are damaged. Appears with a bilateral and to a lesser degree with a unilateral 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 conjunction with the proximity of the location, bulbar and pseudobulbar paralysis are rare.

Clinical picture

With bulbar syndrome, dysarthria and dysphagia are noted. Patients, as a rule, choke on liquid, in some cases they are not able to carry out a swallowing movement. In connection 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 the pharyngeal and palatine reflexes fall out. In seriously ill patients, as a rule, disorders of the rhythm of breathing and cardiac work 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 the head nerves, and therefore the latter can be involved in the disease process.

The 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, non-compliance with the innervation of the muscles of the soft palate, pharynx and larynx occurs, which explains the formation of a standard symptom complex.

Symptoms

Bulbar and pseudobulbar palsy have the following symptoms:

• Dysarthria. Speech in patients becomes deaf, blurry, slurred, nasal, and sometimes aphonia (loss of sonority of the voice) can be observed.
• Dysphagia. Patients can not 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 palatine reflexes may completely disappear.

myasthenia gravis

Myasthenia is manifested by the following symptoms:

• causeless fatigue of various muscle groups;
• double vision;
• drooping of the upper eyelid;
• weakness of mimic muscles;
• decrease in visual acuity.

Aspiration syndrome

Aspiration syndrome manifests itself:

• ineffective cough;
• shortness of breath with involvement in the act of breathing of auxiliary muscles and wings of the nose;
• difficulty breathing on inspiration;
• wheezing wheezes on exhalation.

Respiratory pathologies

Most often manifested:

• chest pain;
• rapid breathing and heartbeat;
• shortness of breath;
• cough;
• swelling of the neck veins;
• blueing of the 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 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.

Difference

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 located in it. Pseudobulbar - insensitivity of cortical-nuclear connections.

Hence the difference in symptoms:

• bulbar paralysis is much more severe and poses a great threat to life (stroke, infections, botulism);
• a reliable indicator of the bulbar syndrome is a violation of breathing and heart rhythm;
• with pseudobulbar paralysis, there is no process of muscle reduction and recovery;
• pseudo-syndrome is indicated by specific movements of the mouth (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, significant differences are also observed 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 levels.

Diagnostics

Bulbar and pseudobulbar palsy are disorders of the central nervous system. They are very similar in symptoms, but at the same time 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 such manifestations: swallowing dysfunction (dysphagia), voice dysfunction, 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 paralysis, these 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 parts of the brain are damaged, 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 and antimicrobial agents must be used. Treatment in this case can 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, the following is prescribed:

• eating with a probe;
• artificial ventilation of the lungs;
• "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 ensure the preservation and improvement of 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, it is not possible to completely cure pseudobulbar palsy, since such disorders develop as a result of pronounced brain lesions, and bilateral ones. 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.

Effects

Despite similar symptoms and manifestations, bulbar and pseudobulbar disorders have a different etiology 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 regions of the brain, respiratory distress and heart failure can develop, which, in turn, is fraught with death.

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 the muscles of the body;
• limb paresis.

In addition, due to the softening of certain parts of the brain, the patient may experience memory impairment, dementia, impaired motor functions.

Bulbar syndrome (paralysis) occurs with peripheral paralysis of the muscles innervated by the IX, X and XII pairs of cranial nerves in case of their combined damage. In the clinical picture, there are: dysphagia, dysphonia or aphonia, dysarthria or anarthria.

Pseudobulbar syndrome (paralysis)- this is a central paralysis of the muscles innervated by the IX, X and XII pairs of cranial nerves. The clinical picture of the pseudobulbar syndrome resembles that of the bulbar syndrome (dysphagia, dysphonia, dysarthria), but it is much milder. By its nature, pseudobulbar palsy is a central paralysis and, accordingly, the symptoms of spastic paralysis are inherent in it.

Often, despite the early use of modern drugs, complete recovery from bulbar and pseudobulbar syndromes (paralysis) does not occur, especially when months and years have passed after the injury.

However, a very good result is achieved with the use of stem cells in bulbar and pseudobulbar syndromes (paralysis).

Stem cells introduced into the body of a patient with bulbar or pseudobulbar syndrome (paralysis) not only physically replace the defect in the myelin sheath, but also take on the function of damaged cells. Embedding in the patient's body, they restore the myelin sheath of the nerve, its conductivity, strengthen and stimulate it.

As a result of treatment in patients with bulbar and pseudobulbar syndrome (paralysis), dysphagia, dysphonia, aphonia, dysarthria, anarthria disappear, brain functions are restored, and the person returns to normal life.

Pseudobulbar palsy

Pseudobulbar palsy (synonymous with false bulbar palsy) is a clinical syndrome characterized by disorders of chewing, swallowing, speech, and facial expressions. It occurs when there is a break in the central pathways going from the motor centers of the cerebral cortex to the motor nuclei of the cranial nerves of the medulla oblongata, in contrast to bulbar paralysis (see), in which the nuclei themselves or their roots are affected. Pseudobulbar paralysis develops only with bilateral damage to the cerebral hemispheres, since a break in the paths to the nuclei of one hemisphere does not give noticeable bulbar disorders. The cause of pseudobulbar paralysis is usually atherosclerosis of the cerebral vessels with softening foci in both hemispheres of the brain. However, pseudobulbar paralysis can also be observed in the vascular form of syphilis of the brain, neuroinfections, tumors, degenerative processes that affect both hemispheres of the brain.

One of the main symptoms of pseudobulbar palsy is a violation of chewing and swallowing. Food gets stuck behind the teeth and on the gums, the patient chokes when eating, liquid food flows out through the nose. The voice acquires a nasal tone, becomes hoarse, loses intonation, difficult consonants fall out completely, some patients cannot even speak in a whisper. Due to bilateral paresis of the facial muscles, the face becomes amimic, mask-like, and often has a weeping expression. Attacks of violent convulsive crying and laughter are characteristic, occurring without corresponding emotions. Some patients may not have this symptom. The tendon reflex of the lower jaw increases sharply. There are symptoms of the so-called oral automatism (see Reflexes). Often, pseudobulbar syndrome occurs simultaneously with hemiparesis. Patients often have more or less pronounced hemiparesis or paresis of all limbs with pyramidal signs. In other patients, in the absence of paresis, a pronounced extrapyramidal syndrome appears (see Extrapyramidal system) in the form of slowness of movement, stiffness, increased muscle tone (muscle rigidity). The intellectual impairment observed in pseudobulbar syndrome is explained by multiple foci of softening in the brain.

The onset of the disease in most cases is acute, but sometimes it can develop gradually. In most patients, pseudobulbar palsy occurs as a result of two or more attacks of cerebrovascular accident. Death occurs from bronchopneumonia caused by food entering the respiratory tract, an associated infection, stroke, etc.

Treatment should be directed against the underlying disease. To improve the act of chewing, you need to prescribe prozerin 0.015 g 3 times a day with meals.

Pseudobulbar palsy (synonym: false bulbar palsy, supranuclear bulbar palsy, cerebrobulbar palsy) is a clinical syndrome characterized by disorders of swallowing, chewing, phonation and articulation of speech, as well as amimia.

Pseudobulbar paralysis, in contrast to the bulbar paralysis (see), which depends on the defeat of the motor nuclei of the medulla oblongata, occurs as a result of a break in the paths going from the motor zone of the cerebral cortex to these nuclei. With the defeat of the supranuclear pathways in both hemispheres of the brain, the voluntary innervation of the bulbar nuclei falls out and “false” bulbar palsy occurs, false because the anatomically the medulla oblongata itself does not suffer. The defeat of the supranuclear pathways in one hemisphere of the brain does not give noticeable bulbar disorders, since the nuclei of the glossopharyngeal and vagus nerves (as well as the trigeminal and upper branches of the facial nerve) have bilateral cortical innervation.

Pathological anatomy and pathogenesis. With pseudobulbar paralysis, in most cases, there is severe atheromatosis of the arteries of the base of the brain, affecting both hemispheres while maintaining the medulla oblongata and pons. More often, pseudobulbar palsy occurs due to thrombosis of the arteries of the brain and is observed mainly in old age. In middle age, P. p. can be caused by syphilitic endarteritis. In childhood, P. p. is one of the symptoms of cerebral palsy with bilateral lesions of the corticobulbar conductors.

The clinical course and symptomatology of pseudobulbar palsy are characterized by bilateral central paralysis, or paresis, of the trigeminal, facial, glossopharyngeal, vagus, and hypoglossal cranial nerves in the absence of degenerative atrophy in paralyzed muscles, preservation of reflexes, and disorders of the pyramidal, extrapyramidal, or cerebellar systems. Swallowing disorders in P. p. do not reach the degree of bulbar paralysis; due to weakness of the masticatory muscles, patients eat extremely slowly, food falls out of the mouth; patients choke. If food enters the respiratory tract, aspiration pneumonia may develop. The tongue is immobile or protrudes only to the teeth. Speech is insufficiently articulated, with a nasal tinge; the voice is quiet, the words are difficult to pronounce.

One of the main symptoms of pseudobulbar palsy is attacks of convulsive laughter and crying, which are of a violent nature; the facial muscles, which in such patients cannot voluntarily contract, come into excessive contraction. Patients may begin to cry involuntarily when showing their teeth, stroking a piece of paper on their upper lip. The occurrence of this symptom is explained by a break in the inhibitory pathways leading to the bulbar centers, a violation of the integrity of the subcortical formations (the visual tubercle, the striatum, etc.).

The face acquires a mask-like character due to bilateral paresis of the facial muscles. During attacks of violent laughter or crying, the eyelids close well. If you ask the patient to open or close his eyes, he opens his mouth. This peculiar disorder of voluntary movements should also be attributed to one of the characteristic signs of pseudobulbar paralysis.

There is also an increase in deep and superficial reflexes in the area of ​​chewing and facial muscles, as well as the emergence of reflexes of oral automatism. This should include Oppenheim's symptom (sucking and swallowing movements when touching the lips); labial reflex (contraction of the circular muscle of the mouth when tapping in the region of this muscle); Bechterew's oral reflex (lip movements when tapping with a hammer in the circumference of the mouth); Toulouse-Wurp buccal phenomenon (movement of the cheeks and lips is caused by percussion along the lateral part of the lip); Astvatsaturov's nasolabial reflex (proboscis-like closing of the lips when tapping on the root of the nose). When stroking the patient's lips, a rhythmic movement of the lips and lower jaw occurs - sucking movements, sometimes turning into violent crying.

There are pyramidal, extrapyramidal, mixed, cerebellar and childhood forms of pseudobulbar palsy, as well as spastic.

The pyramidal (paralytic) form of pseudobulbar palsy is characterized by more or less pronounced hemi- or tetraplegia or paresis with increased tendon reflexes and the appearance of pyramidal signs.

Extrapyramidal form: slowness of all movements, amimia, stiffness, increased muscle tone according to the extrapyramidal type with a characteristic gait (small steps) come to the fore.

Mixed form: a combination of the above forms P. p.

Cerebellar form: atactic gait, coordination disorders, etc. come to the fore.

The children's form of P. of the item is observed at a spastic diplegia. At the same time, the newborn sucks poorly, chokes and chokes. In the future, violent crying and laughter appear in the child, and dysarthria is found (see Infantile paralysis).

Weil (A. Weil) describes the family spastic form of P. p. With it, along with the pronounced focal disorders inherent in P. p., a noticeable intellectual retardation is noted. A similar form was also described by M. Klippel.

Since the symptom complex of pseudobulbar palsy is due mostly to sclerotic lesions of the brain, in patients with P. p., the corresponding mental symptoms are often detected:

memory, difficulty thinking, increased efficiency, etc.

The course of the disease corresponds to the variety of causes that cause pseudobulbar palsy and the prevalence of the pathological process. The development of the disease is most often stroke-like with different periods between strokes. If after a stroke (see) the paretic phenomena in extremities decrease, then the bulbar phenomena remain mostly persistent. More often, the patient's condition worsens due to new strokes, especially with atherosclerosis of the brain. The duration of the disease is varied. Death occurs from pneumonia, uremia, infectious diseases, new hemorrhage, nephritis, heart weakness, etc.

The diagnosis of pseudobulbar palsy is not difficult. It should be differentiated from various forms of bulbar paralysis, neuritis of the bulbar nerves, parkinsonism. Against apoplectic bulbar palsy speaks the absence of atrophy and increased bulbar reflexes. It is more difficult to distinguish P. p. from Parkinson's disease. It has a slow course, in the later stages apoplectic strokes occur. In these cases, attacks of violent crying are also observed, speech is upset, patients cannot eat on their own. The diagnosis can present difficulties only in delimitation of an atherosclerosis of a brain from a pseudobulbar component; the latter is characterized by gross focal symptoms, strokes, etc. Pseudobulbar syndrome in these cases may appear as an integral part of the underlying suffering.

Bulbar and pseudobulbar syndromes

In the clinic, not isolated, but combined damage to the nerves of the bulbar group or their nuclei is more often observed. Symitomocomplex of movement disorders that occurs when the nuclei or roots of the IX, X, XII pairs of cranial nerves at the base of the brain are damaged is called the bulbar syndrome (or bulbar paralysis). This name comes from lat. bulbus bulb (the old name for the medulla oblongata, in which the nuclei of these nerves are located).

Bulbar syndrome can be unilateral or bilateral. With bulbar syndrome, peripheral paresis or paralysis of muscles occurs, which are innervated by the glossopharyngeal, vagus and hypoglossal nerves.

With this syndrome, first of all, swallowing disorders are observed. Normally, when eating, food is directed to the throat with the tongue. At the same time, the larynx rises up, and the root of the tongue presses down on the epiglottis, covering the entrance to the larynx and opening the way for the food bolus to the pharynx. The soft palate rises, preventing liquid food from entering the nose. With bulbar syndrome, paresis or paralysis of the muscles that perform the act of swallowing occurs, as a result of which swallowing is disturbed - dysphagia. The patient chokes while eating, swallowing becomes difficult or even impossible (aphagia). Liquid food enters the nose, solid food can enter the larynx. Food entering the trachea and bronchi can cause aspiration pneumonia.

In the presence of bulbar syndrome, voice and articulation disorders also occur. The voice becomes hoarse (dysphonia) with a nasal tinge. Paresis of the tongue causes a violation of the articulation of speech (dysarthria), and its paralysis causes anarthria, when the patient, having a good understanding of the speech addressed to him, cannot pronounce the words himself. The tongue atrophies, with the pathology of the nucleus of the XII pair, fibrillar muscle twitches are noted in the tongue. The pharyngeal and palatal reflexes decrease or disappear.

With bulbar syndrome, autonomic disorders (respiratory disorders, cardiac activity) are possible, causing in some cases an unfavorable prognosis. Bulbar syndrome is observed with tumors of the posterior cranial fossa, ischemic stroke in the medulla oblongata, syringobulbia, amyotrophic lateral sclerosis, tick-borne encephalitis, post-diphtheria polyneuropathy and some other diseases.

Central paresis of the muscles innervated by the bulbar nerves is called pseudobulbar syndrome. It occurs only with bilateral damage to the cortical-nuclear pathways that go from the motor cortical centers to the nuclei of the nerves of the bulbar group. The defeat of the cortical-nuclear pathway in one hemisphere does not lead to such a combined pathology, since the muscles innervated by the bulbar nerves, except for the tongue, receive bilateral cortical innervation. Since the pseudobulbar syndrome is a central paralysis of swallowing, phonation and articulation of speech, it also causes dysphagia, dysphonia, dysarthria, but unlike the bulbar syndrome, there is no atrophy of the muscles of the tongue and fibrillar twitches, the pharyngeal and palatine reflexes are preserved, and the mandibular reflex increases. With pseudobulbar syndrome, reflexes of oral automatism appear in patients (proboscis, nasolabial, palmar-chin, etc.), which is explained by disinhibition with bilateral lesions of the cortical-nuclear pathways of subcortical and stem formations, at the level of which these reflexes are closed. For this reason, violent crying or laughter sometimes occurs. With pseudobulbar syndrome, movement disorders may be accompanied by a decrease in memory, attention, and intelligence. Pseudobulbar syndrome is most often observed in acute disorders of cerebral circulation in both hemispheres of the brain, dyscirculatory encephalopathy, amyotrophic lateral sclerosis. Despite the symmetry and severity of the lesion, the pseudobulbar syndrome is less dangerous than the bulbar syndrome, since it is not accompanied by a violation of vital functions.

With bulbar or pseudobulbar syndrome, it is important to carefully care for the oral cavity, monitor the patient while eating to prevent aspiration, and tube feeding with aphagia.