Monday, 13 September 2010

MRCP revision battle 10.3: Bulbar Palsy

Bulbar palsy refers to palsy of the nerves coming from the 'bulbar' part of the brain, ie the pons, medulla and cerebellum.  These are VII, VIII, IX, X, XI and XII.

Classically bulbar palsy presents as palsy of tongue, muscles of chewing and swallowing and facial muscles.

Signs are LMN:
  • flaccid tongue
  • fasciculating tongue
  • absent or normal jaw jerk
  • loss of gag reflex
  • quiet/horse voice

Causes of bulbar palsy include:
  • MND
  • syringobulbia (more about this condition tomorrow!)
  • GBS (also lined up for battle tomorrow)
  • polio
  • Lyme disease
  • brain-stem tumours

Next up: battle 10.4, pseudobulbar palsy