Bulbar Syndrome: Symptoms, Causes, Treatment

Bulbar syndrome, called bulbar paralysis, is a syndrome of damage to the sublingual, glossopharyngeal and vagal cranial nerves, whose nuclei are located in the medulla oblongata. Bulbar syndrome occurs with bilateral (less often with unilateral) damage to the X, IX, XI and XII nuclei of the cranial nerves related to the caudal group and embedded in the medulla oblongata. In addition, the roots and nerve trunks inside the cranial cavity and beyond it are damaged.

With bulbar syndrome, peripheral paralysis of the muscles of the pharynx, lips, tongue, soft palate, epiglottis and vocal folds occurs. The result of such paralysis is dysphagia (dysfunction of swallowing) and dysarthria (speech disturbance). Bulbar dysarthria is characterized by a weak and deaf voice, up to full aphonia, there is a nasal and "blurry" sounds. The pronunciation of consonant sounds differing in the place of articulation (front, tongue, back, and tongue) and in the manner of formation (crevice, stop, soft, hard) becomes the same, and the vowels are hardly distinguishable from each other. Speech in patients diagnosed with "bulbar syndrome" is slowed and very fatiguing patients. Depending on the severity of the muscle paresis and its prevalence, the syndrome of bulbar dysarthria can be global, partial or selective.

Patients with bulbar paralysis are pressured even by liquid food, because Not able to produce swallowing, in especially severe cases, patients develop disorders of cardiac activity and respiratory rhythms, which often leads to death. Therefore, timely urgent care for patients with this syndrome is extremely important. It consists in eliminating the threat of life and then transporting it to a specialized medical institution.

Bulbar syndrome is typical for the following diseases:

- genetic diseases, such as Kennedy's disease and porphyria;

- Vascular disease (myocardial infarction);

- syringobulbia, motor neuron disease;

- Inflammatory-infectious diseases (Lyme disease, Guillain-Barre syndrome);

- Oncological diseases (brain stem glioma).

The basis for the diagnosis of bulbar paralysis is the identification of characteristic signs or clinical symptoms. The most reliable methods of diagnosing this disease include data of electromyography and direct examination of the oropharynx.

There are bulbar and pseudobulbar syndromes. The main difference between them is that with pseudobulbar syndrome paralyzed muscles do not become atrophied, i.e. Paralysis is peripheral, there are no fibrillar twitches of the muscles of the tongue and the reaction of rebirth. Pseudobulbar paralysis is often accompanied by violent crying and laughter, which are caused by a disruption of the connections between the central subcortical nodes and the cortex. Pseudobulbar syndrome in contrast to the bulbar does not cause apnea (stopping breathing) and disturbances in the rhythm of cardiac activity. It is observed mainly in diffuse lesions of the brain, which have vascular, infectious, intoxication or traumatic genesis.

Bulbar syndrome: treatment.

Treatment of bulbar paralysis is directed, mainly, to the elimination of the underlying disease and compensation of the functions that are violated. To improve the function of swallowing prescribed drugs such as glutamic acid, proserine, nootropic drugs, galantamine and vitamins, and with increased salivation - the drug atropine. Feeding such patients is done through a probe, i.e. Enterally. If there is a violation of the respiratory function, artificial ventilation is prescribed.