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Bulbar and pseudo-bulbar palsy A bulbar palsy descrites a lower motor neurone lesion resulting in weakness of the muscles supplied by those cranial nerves whose nuclei lie in the medulla (or bulb), ie IX-XIL It is very unusual in children, A pseudo-bulbar palsy results from bilateral supranuclear upper motor neurone lesions of the lower cranial nerves, resulting in poor tongue and pharynx movement. This is far more common than bulbar palsy, particularly in association with spastic quadriplegia. Signs of a pseudo-bulbar palsy D Stiff spastic tongue that is not wasted © ‘Dry’ voice and dysarthria > Preserved gag and palatal reflexes © Exaggerated jaw jerk Bulbar & Pseudobulbar palsy » Bulbar Palsy > Is caused by bilateral lower motor neuron lesion affecting the nerves supplying the bulbar muscles. of the jaw, face, palate, pharynx & larynx. > O/F Impaired speech and swallowing Speech develops a nasal quality due to escape of air through nose. Paralysis of affected muscles, and tongue appears wasted. a Pseudo bulbar palsy cont... >» Presentation Tongue - paralysed, no wasting initially and no fasciculations; “Donald duck" speech; unable to protrude » Palatal movements absent Dribbling persistently Facial muscles — may also be paralysed Reflexes - exaggerated e.g. jaw jerk Nasal regurgitation may be present Dysphonic Dysphagic Emotional lability may also be present There may also be neurological deficits in the limbs e.g. increased tone, enhanced reflexes and weakness.