Violation of the cranial nerves, the nucleus of which are located in the medulla oblongata, called bulbar syndrome. The main characteristic of the disease is the common language of paralysis, the muscles of the pharynx, mouth, epiglottis, vocal cords, and soft palate. Often the result of bulbar syndrome (paralysis) is a disorder of the vocal apparatus, the functions of swallowing, chewing and breathing.
Less pronounced degree of paralysis is manifested in the case of unilateral lesions nuclei IX, X, XI and XII (caudal group) nerves, their trunks and roots in the medulla oblongata, but more frequent severe degree bulbar syndrome with bilateral lesions of the same nerves.
Pseudobulbar syndrome called bilateral interruption of the cortico-nuclear tract, leading to neurological syndrome. With bulbar syndrome, it is similar clinical picture, however, it has a number of distinctive features and occur due to destruction of other departments and structures of the brain.
The essential difference between the bulbar and pseudobulbar syndrome is that when there is no breach of the second heart rhythm, atrophy of paralyzed muscles, as well as cessation of breathing (apnea). Often it is accompanied by violent unnatural laughter and crying patient arising from violations of the relationship between the central nodes and subcortical cerebral cortex. Most often, pseudobulbar palsy occurs in diffuse brain lesions with traumatic, vascular, or infectious origin intoxication.
Bulbar syndrome: Causes
The list of possible causes of paralysis is quite wide, it includes genetic, vascular, degenerative and infectious factors. So, for genetic reasons include acute intermittent porphyria and myasthenia amyotrophies Kennedy to degenerative - siringobulbiyu, Lyme disease, polio and Guillain-Barre syndrome. The cause of the bulbar syndrome can also act medulla stroke (ischemic), which more often than other diseases fatal.
Development of the bulbar syndrome occurs in amyotrophic lateral sclerosis, periodic paralysis, spinal amyotrophy Fazio-Londe, diphtheria, of post-paraneoplastic polyneuropathy, and also due to hyperthyroidism.
Other probable causes of bulbar syndrome rank such diseases and processes in the posterior fossa, brain and craniospinal area as:
- The tumor in the medulla oblongata;
- Bone abnormalities;
- Granulomatous disease;
Against the background of periodic paralysis, myasthenia gravis, dystrophic myotonia, okulofaringealnoy myopathy, Kearns-Sayre syndrome, psychogenic dysphonia and dysphagia may also develop paralysis.
Symptoms of bulbar syndrome
When paralysis patients have problems with the consumption of liquid food, they often poperhivayutsya it, and sometimes can not reproduce swallowing movements, which is why from the corners of their mouth saliva can flow.
In severe cases, bulbar syndrome may occur disorder of cardiovascular activity and respiratory rate, due to the close proximity of the nuclei of cranial nerves caudal group with centers of respiratory and cardiovascular systems. This involvement in the pathological process of cardiac and respiratory systems are often fatal.
A sign of the bulbar syndrome is loss of palatal and pharyngeal reflexes, as well as atrophy of the muscles of the tongue. This is due to the defeat of the nuclei of nerves IX and X, which are part of reflex arcs above reflexes.
The most common symptoms of bulbar syndrome are as follows:
- The lack of facial expression in the patient, he can not swallow, fully chew food;
- Violation of phonation;
- Contact with liquid food after eating the nasopharynx;
- Violation of the heart;
- Nasal and slurred speech;
- In case of unilateral bulbar syndrome observed deviation language unaffected side paralysis, his twitching and drooping of the soft palate;
- Respiratory failure;
- The lack of the palatal and pharyngeal reflex;
- Arrhythmia pulse.
The symptoms of paralysis in each case may be of varying severity and complexity.
Diagnosis bulbar syndrome
Before proceeding to the immediate treatment, the doctor must carry out inspection of the patient, especially oropharyngeal region, identify all of the symptoms of the disease, to conduct electromyography, according to which it is possible to determine the severity of paralysis.
Treatment bulbar syndrome
In some instances, to save the patient's life at the bulbar syndrome requires preliminary emergency care. The main objective of this assistance is to eliminate the threat to the life of the patient before it is transported to a medical facility, which will then be chosen and assigned to appropriate treatment.
The doctor, depending on the clinical symptoms and character pathology, can predict the outcome of the disease, and the effectiveness of the alleged treatment of bulbar syndrome, which is carried out in several stages, namely:
- Reviving, support the functions of the body that have been broken due to paralysis - ventilation to restore breathing, use of neostigmine, adenosine triphosphate and vitamins to start swallowing reflex, the appointment of Atropine to reduce salivation;
- Followed by symptomatic therapy aimed at alleviating the patient's condition;
- Treatment of the disease, against which there was the development of bulbar syndrome.
Feeding patients with paralysis enterally performed by the food probe.
Bulbar syndrome is a disease that occurs due to disruption of the cranial nerves. Often, even when applying the appropriate treatment, to achieve 100% recovery of the patient is obtained only in a few cases, however, significantly improve the patient feels quite real.