Pseudobulbar palsy

Pseudobulbar palsy (synonym false bulbar palsy) is a clinical syndrome characterized by disorders of chewing, swallowing, speech, facial expressions. It occurs when the break of the Central ways coming from the motor centers of bark of the big hemispheres of the brain to motor nuclei of the cranial nerves of the medulla oblongata, unlike the tabloid paralysis (see), which afflicts themselves kernel or their roots. Pseudobulbar paralysis develops only when bilateral lesions of the brain hemispheres, because the break of paths to the nuclei of one hemisphere is no significant bulbar disorders. The reason pseudobulbar palsy usually is atherosclerosis of cerebral vessels with the centers softening in both hemispheres of the brain. However, pseudobulbar paralysis may also occur in vascular form of syphilis of the brain, neuroinfections, tumors, degenerative processes that affect both hemispheres of the brain.
One of the main symptoms of pseudobulbar palsy is a violation of chewing and swallowing. The food gets stuck for teeth and gums, sore poprivate in food, food-based fluids flows through your nose. The voice becomes nasal hue becomes hoarse, loses intonation, hard consonants quite a fall, some people can't even speak in a whisper. Due to bilateral paresis of the facial muscles of the face becomes mimicry, masloobraznyj, it is often crying expression. Characterized by bouts of violent convulsive weeping and laughter, coming without the appropriate emotions. In some patients, this symptom can be absent. Tendon reflex lower jaw increases. Symptoms of so-called oral automatism (see Reflexes). Often pseudobulbar syndrome occurs simultaneously with hemiparesis. Patients are often more or less pronounced hemiparesis or paralysis of all limbs with pyramid marks. Other patients in the absence of paresis appears pronounced extrapyramidal syndrome (see Extrapyramidal system) in the form of slowness of movement, stiffness, increase of a tone of muscles (rigidity of muscles). Observed at pseudobulbar syndrome, mental disorders are explained by multiple centers softening in the brain.
The onset of the disease in most cases, acute, but sometimes can develop gradually. In most patients pseudobulbar palsy is the result of two or more attacks a breach of cerebral circulation. Death from pneumonia, caused by the ingestion of food in the respiratory tract, acceding infection, stroke, and other
Treatment should be directed at the underlying disease. To improve the act of chewing need to assign neostigmine 0.015 g 3 times a day during meals.

Pseudobulbar palsy (synonym: false bulbar paralysis, supranuclear bulbar paralysis, cerebrally palsy) is a clinical syndrome that is characterized by disorders of swallowing, chewing, phonation, and articulation of speech and amonia.
Pseudobulbar palsy, unlike the tabloid paralysis (see), depending on the defeat of motor nuclei of medulla oblongata, occurs as a result of break of ways, coming from the motor areas of the cerebral cortex to these nuclei. With the defeat of supranuclear ways in both hemispheres of the brain falls arbitrary innervation tabloid nuclei and there is "false" bulbar paralysis, false because anatomically himself the medulla not suffer. Defeat supranuclear ways in one hemisphere of the brain is no significant bulbar disorders, since the kernel language-pharyngeal and vagus nerves (like trigeminal, and upper branches of the facial nerve) have bilateral cortical innervation.
Pathology and pathogenesis. When pseudobulbar paralysis in most cases there is heavy atheromatous arteries of the base of the brain, affecting both hemispheres with the preservation of the medulla oblongata and bridge. More often pseudobulbar paralysis occurs due to thrombosis of arteries of the brain and is observed mainly in old age. The average age of the PP can be caused by syphilis endarteritis. In childhood PP is one of the symptoms of children with cerebral palsy with bilateral lesions corticobulbar conductors.
Clinical course and the symptomology of pseudobulbar palsy characterized by bilateral Central paralysis, or paresis, trigeminal, facial, language-pharyngeal, wandering and sublingual craniocerebral nerves in the absence of degenerative atrophy in paralyzed muscles, maintaining reflexes and violations of the pyramid, extrapyramidal or cerebellar systems. Disorders swallowing when p.p. not reach a state of bulbar palsy; the weakness of masticatory muscles patients eat very slowly, the food falls out of his mouth; patients popieriaus. By ingestion of food in the respiratory tract may develop aspiration pneumonia. Language fixed or extended only to the teeth. It is not enough articulated, with your shade; the voice, words vigoureuse with difficulty.
One of the main symptoms of pseudobulbar palsy - seizures convulsions of laughter and tears, violent nature; facial muscles, which in these patients cannot arbitrarily reduced, come in too short. Patients may involuntarily begin to cry when displaying teeth, stroking his paper on the upper lip. The appearance of this symptom explain break inhibitory pathways going to bulbar centers, violation of the integrity subcortical formations (visual hill, striatum and other).
A person acquires masloobraznyj due to the nature of bilateral paresis of the facial muscles. When the attacks of violent laughter or crying forever well closed. If to ask the patient to open or close his eyes, he opens his mouth. This kind of disorder of voluntary movements should also be attributed to one of the characteristic features of pseudobulbar palsy.
Notes and improvement of deep and superficial reflexes in the field of chewing and facial muscles, as well as the emergence of reflexes oral automatism. This included a symptom Oppenheim (sucking and swallowing at zatragivanija to the lips); mouth reflex (reduction circular muscles of the mouth when we tap into this muscle); oral reflex Bekhterev (lip when tapping with a hammer around the mouth); genal phenomenon Toulouse - Vucha (movement of the cheeks and lips caused by percussion on the side of the lip); nasolabial reflex astvatsaturova (homotaurine closing lips when tapped on the root of the nose). When stroking the lips of the patient occurs rhythmic movement of the lips and the lower jaw - sucking motion, turning occasionally violent weeping.
There are pyramidal, extrapyramidal, mixed, cerebellar and children form pseudobulbar paralysis and spastic.

Pyramid (paralytic) form of pseudobulbar paralysis is characterized by a more or less clearly expressed Hemi - or tetraplegia or paresis with the increase of tendon reflexes and the emergence of the pyramid marks.
Extrapyramidal form: at the forefront are the slowness of all movements, Amemiya, stiffness, increased muscle tone of extrapyramidal type with characteristic gait (small steps).
Mixed form: a combination of the above forms of p. P.
Cerebellar form: to the forefront ataxic gait, coordination disorders, etc.
Children form p.p. observed in spastic diplegia. Newborn when this bad sucks, breathless and poprivate. In the future the child appeared violent weeping and laughter, and found dysarthria (see Infant paralysis).
Weyl (A. Weil) described family spastic form p.p. When it is celebrated along with severe bronchial disorders inherent PP, prominent intellectual backwardness. A similar form, was also described by Clippele (M Klippel).
Because syndrome pseudobulbar palsy is caused mostly sclerotic lesions of the brain in patients PP often are identified and corresponding symptoms and psyche: reduction
memory, difficulty thinking, high efficiency, etc.,
The disease meets the variety of causes of pseudobulbar palsy, and extent of the pathological process. The disease often inculturation with different periods between strokes. If after a stroke (see) pateticheskaya phenomena in the limbs decrease, bulbar phenomena remain largely stable. Often the patient's condition worsens due to new stroke, particularly in atherosclerosis of the brain. The duration of the disease is varied. Death from pneumonia, uremia, infectious diseases, new bleedings, nephritis, heart failure and other
Diagnosis of pseudobulbar palsy is not difficult. Should be differentiated from various forms tabloid paralysis, bulbar neuritis nerves, parkinsonism. Against applicationscope bulbar palsy says no atrophy and increase bulbar reflexes. Harder to distinguish p.p. from parkinsonaposs disease. It has a slow flow, in the late stages come apoplectically strokes. In these cases, there are also violent attacks of crying, upset speech, patients are unable to eat. The diagnosis may present difficulties only in the delimitation of atherosclerosis of the brain from pseudobulbar component; the latter is characteristic rough focal symptoms, strokes and other Pseudobulbar syndrome in these cases, it may appear as a part of the main disease.