Bulbar palsy l Bulbar weakness l Amc doctor interview l Army medical corps l capf l Interview guide

Bulbar palsy l Bulbar weakness l Amc doctor interview l Army medical corps l capf l Interview guide
Bulbar relates to the medulla. Bulbar palsy is the result of diseases affecting the lower cranial nerves. A speech deficit occurs due to paralysis or weakness of the muscles of articulation which are supplied by these cranial nerves. The causes of this are broadly divided into:
Muscle disorders.
Diseases of the motor nuclei in the medulla and lower pons.
Diseases of the intramedullary nerves of the spinal cord.
Diseases of the peripheral nerves supplying the muscles.
Importantly, these lesions do not affect speech in isolation. The bulbar nerves also innervate muscles involved in swallowing and facial muscles.

Bulbar palsy is sometimes also classified as non-progressive or progressive. Non-progressive bulbar palsy is an uncommon condition of uncertain aetiology and there are few reports of it in the literature[3]. Progressive bulbar palsy can occur in children or adults and form a spectrum of severity, based around the common feature of bulbar dysfunction and motor neurone degeneration. Genetic abnormalities have been identified in some cases presenting in childhood.
Bulbar palsy symptoms

Progressive bulbar palsy is a condition presenting with bulbar weakness. The differential is quite broad because patients can present with either pure lower motor neuron or pure upper motor neuron findings. Detailed neuroimaging is critical in a pure upper motor neuron presentation to look for any evidence of a structural lesion, such as stroke, tumor, or multiple sclerosis. A lumbar puncture, with a large volume of cerebrospinal fluid sent for cytology, is important to aid in the diagnosis if neuroimaging is negative. When both upper and lower motor neuron findings are present and basic blood work, neuroimaging, and lumbar puncture results are negative, there is not much utility in further evaluations, because ALS is the most likely diagnosis. However, it may take years for the disease to involve the limbs. An EMG study can be useful to document the lower motor neuron involvement in the tongue and to establish any subclinical disease in the limbs.
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