Bulbar Syndrome - Causes, Symptoms, Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Bulbar syndrome

Dysfunction of the cranial nerves, the nuclei of which are located in the medulla oblongata, is called bulbar syndrome. The main characteristic of the disease is a general paralysis of the tongue, muscles of the pharynx, lips, epiglottis, vocal cords and soft palate. Often, a consequence of bulbar syndrome (paralysis) is a disorder of the speech apparatus, the function of swallowing, chewing and breathing.

A less pronounced degree of paralysis is manifested in cases of unilateral damage to the nuclei IX, X, XI and XII (caudal group) of nerves, their trunks and roots in the medulla oblongata, but more often a severe degree of bulbar syndrome occurs with bilateral lesions of the same nerves.

Pseudobulbar syndrome is called bilateral interruption of the cortical-nuclear pathways, leading to a neurological syndrome. With bulbar syndrome, it is similar to the clinical picture, however, it has a number of distinctive features and occurs due to damage to other parts and structures of the brain.

A significant difference between bulbar and pseudobulbar syndrome is that in the second there is no violation of the rhythm of cardiac activity, atrophy of paralyzed muscles, as well as respiratory arrest (apnea). Often it is accompanied by unnatural violent laughter and crying of the patient, arising from a violation of the connection between the central subcortical nodes and the cerebral cortex. Most often, pseudobulbar syndrome occurs with diffuse brain lesions that have traumatic, vascular, intoxication, or infectious genesis.

Bulbar syndrome: causes

The list of possible causes of paralysis is quite wide; it includes genetic, vascular, degenerative and infectious factors. So, genetic causes include acute intermittent porphyria and Kennedy's bulbospinal amyotrophy, degenerative ones - syringobulbia, Lyme disease, poliomyelitis and Guillain-Barré syndrome. The cause of bulbar syndrome can also be a stroke of the medulla oblongata (ischemic), which is more fatal than other diseases.

The development of bulbar syndrome occurs with amyotrophic lateral sclerosis, paroxysmal myoplegia, Fazio-Londe spinal amyotrophy, diphtheria, post-vaccination and paraneoplastic polyneuropathy, as well as due to hyperthyroidism.

Other probable causes of bulbar syndrome include such diseases and processes in the posterior cranial fossa, brain and craniospinal region, such as:

• Botulism;
• Tumor in the medulla oblongata;
• Bone abnormalities;
• Siringobulbia;
• Granulomatous diseases;
• Meningitis;
• Encephalitis.

Against the background of paroxysmal myoplegia, myasthenia gravis, dystrophic myotonia, oculopharyngeal myopathy, Kearns-Sayre syndrome, psychogenic dysphonia and dysphagia, paralysis can also develop.

Bulbar Syndrome Symptoms

With paralysis, patients have problems with the consumption of liquid food, they often choke on it, and sometimes they cannot reproduce swallowing movements, which is why saliva can flow from the corners of their mouth.

In particularly severe cases of bulbar syndrome, a disorder of cardiovascular activity and respiratory rhythm may occur, which is due to the close location of the nuclei of the cranial nerves of the caudal group with the centers of the respiratory and cardiovascular systems. Such involvement in the pathological process of the cardiac and respiratory systems is often fatal.

A sign of bulbar syndrome is loss of palatine and pharyngeal reflexes, as well as atrophy of the muscles of the tongue. This is due to damage to the nuclei of the IX and X nerves, which are part of the reflex arcs of the above reflexes.

The most common symptoms of bulbar syndrome are as follows:

• Lack of facial expressions in the patient, he cannot swallow, fully chew food;
• Violation of phonation;
• Ingestion of liquid food after consumption into the nasopharynx;
• Violation of the heart;
• Nasiness and slurred speech;
• In the case of unilateral bulbar syndrome, there is a deviation of the tongue to the side not affected by paralysis, its twitching, as well as the drooping of the soft palate;
• Breathing disorder;
• Lack of palatine and pharyngeal reflex;
• Pulse arrhythmia.

The symptoms of paralysis in each individual case can be of varying severity and complexity.

Diagnostics of the bulbar syndrome

Before proceeding with direct treatment, the doctor must examine the patient, especially the oropharynx area, identify all the symptoms of the disease, conduct electromyography, according to which it is possible to determine the severity of the paralysis.

Treatment of bulbar syndrome

In some cases, to save the life of a patient with bulbar syndrome, preliminary emergency care is required. The main goal of such assistance is to eliminate the threat to the patient's life before he is transported to a medical facility, where adequate treatment will then be selected and prescribed.

The doctor, depending on the clinical symptoms and the nature of the pathology, can predict the outcome of the disease, as well as the effectiveness of the proposed treatment of bulbar syndrome, which is carried out in several stages, namely:

• Resuscitation, support for those body functions that were impaired due to paralysis - artificial ventilation of the lungs to restore breathing, the use of Proserin, adenosine triphosphate and vitamins to trigger the swallowing reflex, the appointment of Atropine to reduce salivation;
• This is followed by symptomatic therapy aimed at alleviating the patient's condition;
• Treatment of the disease, against which the development of bulbar syndrome occurred.

Feeding of patients with paralysis is carried out enterally through a feeding tube.

Bulbar syndrome is a disorder arising from a malfunction of the cranial nerves. Often, even with the use of adequate treatment, it is possible to achieve 100% recovery of the patient only in isolated cases, but it is quite possible to significantly improve the patient's well-being.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!