๐งพ Overview
Bulbar Palsy ๐ง and Pseudobulbar Palsy ๐ฃ๏ธ are neurological conditions affecting the cranial nerves responsible for motor control of the face, throat, and tongue ๐
.
Understanding the differences between these two is crucial for accurate diagnosis ๐ฉบ and effective management.
โ๏ธ Comparison: Bulbar vs Pseudobulbar Palsy
- Neuron Affected ๐งฌ
โข Bulbar: Lower Motor Neuron (LMN) โฌ๏ธ
โข Pseudobulbar: Upper Motor Neuron (UMN) โฌ๏ธ
- Etiology ๐งโโ๏ธ
โข Bulbar: ๐ฆ Polio, ๐งช Guillain-Barrรฉ Syndrome, โก MND, ๐ Syringobulbia, ๐งฌ Neurosyphilis
โข Pseudobulbar: ๐ง Bilateral strokes, ๐ MS plaques, ๐ญ Tumours, โก MND, โณ Progressive Supranuclear Palsy
- Clinical Features ๐
โข Bulbar: ๐
Tongue wasting + fasciculations, ๐ฅค Dysphagia, ๐ฃ๏ธ Dysarthria, ๐ฎโ๐จ Aspiration pneumonia, ๐ง Wet voice
โข Pseudobulbar: ๐ฆท Brisk jaw jerk, ๐
Spastic/weak tongue, ๐ฅค Dysphagia, ๐ค โDonald Duckโ nasal speech, ๐๐ญ Emotional lability, ๐ฏ Dyspraxia
- Cognition ๐ง
โข Bulbar: โ
Usually unaffected
โข Pseudobulbar: โ ๏ธ May be impaired (emotional lability, dyspraxia)
- Management ๐
โข Bulbar: ๐ก๏ธ Protect airway, ๐ฎโ๐จ Prevent aspiration, ๐ฅฃ Nutrition (feeding tubes), ๐ฏ Treat underlying cause
โข Pseudobulbar: Same as above + ๐ง Manage emotional/cognitive symptoms (SSRIs, TCAs)
๐ฌ Pathophysiology
- Bulbar Palsy: LMN lesions in the medulla โ muscle atrophy, weakness, fasciculations.
- Pseudobulbar Palsy: UMN lesions in corticobulbar tracts โ spasticity, hyperreflexia, emotional lability.
๐งโโ๏ธ Clinical Presentation Details
- Bulbar Palsy: Tongue wasting/fasciculations, dysphagia, dysarthria, aspiration pneumonia, wet/gurgly voice.
- Pseudobulbar Palsy: Brisk jaw jerk, spastic tongue, dysphagia, Donald Duck nasal speech, emotional lability, dyspraxia.
๐งช Investigations
- Neurological exam: tone, reflexes, swallowing, emotional lability
- EMG: LMN changes (atrophy, fasciculations)
- MRI/CT: identify structural lesions
- Bloods: infection/inflammation (e.g. Lyme, GBS)
- Genetic testing: MS, PSP, hereditary causes
๐ Management
- Protect airway + prevent aspiration pneumonia
- Nutrition: modified diets, enteral feeding if required
- Speech/swallowing therapy
- Pharmacology: SSRIs/TCAs for emotional lability; Botox for spasticity
- Treat underlying cause (infection, autoimmune, tumour)
- Ongoing monitoring for progression
๐ Prognosis
- Bulbar: Depends on cause. Better in polio; poor in MND. Risk of aspiration pneumonia is high.
- Pseudobulbar: Often chronic (MS, MND). Emotional lability manageable with therapy/meds.
- Overall: Early diagnosis + comprehensive care improves quality of life.
๐ Differential Diagnoses
- Myasthenia Gravis
- Brainstem Stroke
- Multiple Sclerosis
- Progressive Supranuclear Palsy
- Motor Neuron Disease (ALS)
๐ References
- National Institute of Neurological Disorders and Stroke (NINDS): https://www.ninds.nih.gov
- Mayo Clinic: https://www.mayoclinic.org
- American Association of Neurological Surgeons (AANS): https://www.aans.org
- Weinstein SL et al., JNNP 2010
- Bauman ML & Smith D, Neuropsychiatric Disease and Treatment 2012
- Johnston & Myers, Clinical Neuroanatomy, Elsevier 2016