Bulbar paralysis, also known as bulbar palsy, is a clinical syndrome caused by damage to the glossopharyngeal and vagus nerves, primarily characterized by dysarthria and dysphagia.

bubble_chart Etiology

Primary bulbar palsy Bi disease has an unknown cause. Secondary bulbar palsy has more disease causes. Acute cases are commonly seen in inflammations (Guillain-Barré syndrome, acute anterior poliomyelitis), vascular diseases (vertebrobasilar stirred pulse lesions), and demyelinating diseases (multiple sclerosis, etc.). Chronic cases are often seen in motor neuron disease, syringobulbia, and tumors in the skull base and foramen magnum region.

Due to lesions affecting the glossopharyngeal and vagus nerve nuclei, nerve roots, or nerve trunks, it causes paralysis and movement disorders in the soft palate and pharyngeal muscles.

bubble_chart Clinical Manifestations

The most prominent symptoms are dysarthria and dysphagia. Dysarthria initially manifests as difficulty in pronunciation, hoarseness, slurred speech, nasal speech, or even complete aphonia. In mild cases, dysphagia presents as slow swallowing, food regurgitation, and choking. In severe cases, swallowing becomes completely impossible, severely affecting nutritional maintenance. Due to food regurgitation, increased saliva secretion, and choking, aspiration pneumonia often occurs, ultimately leading to death from asphyxia and exhaustion. Difficulty breathing, blood pressure fluctuations, cardiac arrhythmias, and slow pulse are also common and critical symptoms of acute bulbar palsy. Once these symptoms appear, they indicate a poor prognosis.

Examination may reveal an inability to elevate one or both sides of the soft palate. If one side is affected, the uvula is pulled toward the unaffected side, and pharyngeal sensation is reduced or lost. This may be accompanied by tongue muscle paralysis, atrophy, or even difficulty chewing and facial muscle paralysis.

The diagnostic key points are characterized by dysarthria and dysphagia. Examination reveals bulbar palsy (peripheral type).

bubble_chart Treatment Measures

1. disease cause Treatment: For patients with medullary paralysis Bi disease, it is essential to establish a clear diagnosis as soon as possible and eliminate the disease cause whenever feasible.
2. Symptomatic treatment:
   1. Nasogastric feeding should be administered to maintain body nutrition, ensure water and electrolyte balance, and prevent asphyxia and aspiration pneumonia.
   2. For patients experiencing respiratory difficulties, early tracheotomy and the use of a ventilator are recommended.
   3. If an infection is present, appropriate antibiotics should be selected.

bubble_chart Differentiation

1. Central bulbar palsy is also known as upper motor neuron, supranuclear, or pseudobulbar palsy. Its characteristics include:
   1. The lesion involves bilateral cortical or corticobulbar tracts.
   2. The soft palate retains some mobility, the pharyngeal reflex is present, and the jaw jerk is hyperactive.
   3. There is no tongue muscle atrophy or tremor.
   4. Forced crying and laughing are common. It is frequently seen in conditions such as cerebral arteriosclerosis and multiple infarctions.
2. Myogenic bulbar Bi disease involves the muscles innervated by the bulbar nerves or the neuromuscular junction, often bilaterally, without sensory impairment. It is commonly observed in myasthenia gravis, polymyositis, dermatomyositis, or organophosphate poisoning, and is easily distinguishable.