Bulbar palsy syndrome occurs when affected. Bulbar stroke. Causes of the disease

Dysfunction of the cranial nerves, the nuclei of which are located in the medulla oblongata, is called bulbar syndrome. The main characteristic of the disease is general paralysis of the tongue, muscles of the pharynx, lips, epiglottis, vocal cords and soft palate. Often the consequence of bulbar syndrome (paralysis) is a disorder of the speech apparatus, the functions of swallowing, chewing and breathing.

A less pronounced degree of paralysis is manifested in cases of unilateral damage to the nuclei of the IX, X, XI and XII (caudal group) nerves, their trunks and roots in the medulla oblongata, but a severe degree of bulbar syndrome is more common with bilateral damage to the same nerves.

Pseudobulbar syndrome is a bilateral interruption of the corticonuclear pathways, leading to a neurological syndrome. It has a similar clinical picture to bulbar syndrome, but has a number of distinctive features and occurs due to damage to other parts and structures of the brain.

A significant difference between bulbar and pseudobulbar syndrome is that in the second there is no disturbance in the rhythm of cardiac activity, atrophy of paralyzed muscles, or cessation of breathing (apnea). It is often accompanied by unnatural forced laughter and crying of the patient, resulting from a disruption of the connection between the central subcortical nodes and the cerebral cortex. Most often, pseudobulbar syndrome occurs with diffuse brain lesions of traumatic, vascular, intoxication or infectious origin.

Bulbar syndrome: causes

The list of possible causes of paralysis is quite wide, it includes genetic, vascular, degenerative and infectious factors. Thus, genetic causes include acute intermittent porphyria and Kennedy bulbospinal amyotrophy, and degenerative causes include syringobulbia, Lyme disease, polio and Guillain-Barre syndrome. The cause of bulbar syndrome can also be a stroke of the medulla oblongata (ischemic), which is much more likely than other diseases to lead to death.

The development of bulbar syndrome occurs with amyotrophic lateral sclerosis, paroxysmal myoplegia, spinal amyotrophy Fazio-Londe, diphtheria, post-vaccination and paraneoplastic polyneuropathy, as well as due to hyperthyroidism.

Other probable causes of bulbar syndrome include diseases and processes in the posterior cranial fossa, brain and craniospinal region, such as:

Botulism;
Tumor in the medulla oblongata;
Bone abnormalities;
Syringobulbia;
Granulomatous diseases;
Meningitis;
Encephalitis.

Against the background of paroxysmal myoplegia, myasthenia gravis, dystrophic myotonia, oculopharyngeal myopathy, Kearns-Sayre syndrome, psychogenic dysphonia and dysphagia, paralysis can also develop.

Symptoms of bulbar syndrome

With paralysis, patients have problems with the consumption of liquid food, they often choke on it, and sometimes they cannot reproduce swallowing movements, which is why saliva may flow from the corners of their mouth.

In especially severe cases of bulbar syndrome, a disorder of cardiovascular activity and respiratory rhythm may occur, which is due to the close location of the nuclei of the cranial nerves of the caudal group with the centers of the respiratory and cardiovascular systems. Such involvement of the cardiac and respiratory systems in the pathological process often leads to death.

A sign of bulbar syndrome is loss of the palatal and pharyngeal reflexes, as well as atrophy of the tongue muscles. This occurs due to damage to the nuclei of the IX and X nerves, which are part of the reflex arcs of the above reflexes.

The most common symptoms of bulbar syndrome are the following:

The patient lacks facial expressions, he cannot swallow or chew food fully;
Violation of phonation;
Getting liquid food into the nasopharynx after consumption;
Heart dysfunction;
Nasal and slurred speech;
In the case of unilateral bulbar syndrome, there is a deviation of the tongue to the side unaffected by paralysis, its twitching, as well as drooping of the soft palate;
Breathing disorders;
Absence of palatine and pharyngeal reflex;
Pulse arrhythmia.

Symptoms of paralysis in each individual case can be of varying degrees of severity and complexity.

Diagnosis of bulbar syndrome

Before proceeding with direct treatment, the doctor must examine the patient, especially the oropharynx area, identify all the symptoms of the disease, and conduct an electromyography, according to which it is possible to determine the severity of paralysis.

Treatment of bulbar syndrome

In some cases, to save the life of a patient with bulbar syndrome, preliminary emergency care is required. The main goal of such assistance is to eliminate the threat to the patient’s life before he is transported to a medical facility, where adequate treatment will then be selected and prescribed.

The doctor, depending on the clinical symptoms and the nature of the pathology, can predict the outcome of the disease, as well as the effectiveness of the proposed treatment for bulbar syndrome, which is carried out in several stages, namely:

Resuscitation, support of those body functions that were impaired due to paralysis - artificial ventilation to restore breathing, the use of Proserin, adenosine triphosphate and vitamins to trigger the swallowing reflex, the appointment of Atropine to reduce salivation;
This is followed by symptomatic therapy aimed at alleviating the patient’s condition;
Treatment of the disease against which the development of bulbar syndrome occurred.

Patients with paralysis are fed enterally, using a feeding tube.

Bulbar syndrome is a disease that occurs due to disruption of the cranial nerves. Often, even with adequate treatment, it is possible to achieve 100% recovery of the patient only in isolated cases, but it is quite possible to significantly improve the patient’s well-being.

When some areas of the brain are damaged, serious pathological processes can appear that reduce a person’s standard of living, and in some cases, threaten death.

Bulbar and pseudobulbar syndrome are disorders of the central nervous system, the symptoms of which are similar to each other, but their etiology is different.

Bulbar occurs due to damage to the medulla oblongata - the nuclei of the glossopharyngeal, vagus and hypoglossal nerves that are located in it.

Pseudobulbar syndrome (paralysis) manifests itself due to disruption of the conductivity of the corticonuclear pathways.

Clinical picture of bulbar syndrome

The main diseases during or after which bulbar palsy occurs:

stroke affecting the medulla oblongata;
infections (tick-borne borreliosis, acute polyradiculoneuritis);
trunk glioma;
botulism;
displacement of brain structures with damage to the medulla oblongata;
genetic disorders (porphyrin disease, bulbospinal amyotrophy Kennedy);
Syringomyelia.

Porphyria is a genetic disorder that often causes bulbar palsy. The unofficial name - vampire disease - is given because of a person’s fear of the sun and the effect of light on the skin, which begins to burst, become covered with ulcers and scars. Due to the involvement of cartilage in the inflammatory process and deformation of the nose, ears, as well as exposure of teeth, the patient becomes like a vampire. There is no specific treatment for this pathology.

Isolated bulbar palsies are uncommon due to the involvement of the nuclei of nearby structures of the medulla oblongata during the lesion.

The main symptoms that occur in the patient:

speech disorders (dysarthria);
swallowing disorders (dysphagia);
voice changes (dysphonia).

Patients have difficulty speaking indistinctly, their voice becomes weak, to the point that it becomes impossible to make a sound. The patient begins to pronounce sounds through the nose, his speech is blurred and slow. Vowel sounds become indistinguishable from each other. Not only paresis of the tongue muscles, but their complete paralysis may occur.

Patients choke on food and often cannot swallow it. Liquid food enters the nose, and aphagia may occur (complete inability to swallow).

The neurologist diagnoses the disappearance of the soft palate and pharyngeal reflexes and notes the appearance of twitching of individual muscle fibers and muscle degeneration.

In case of severe damage, when the cardiovascular and respiratory centers are involved in the medulla oblongata, disturbances in the rhythm of breathing and heart activity occur, which can be fatal.

Manifestations and causes of pseudobulbar syndrome

Diseases after or during which pseudobulbar palsy develops:

vascular disorders affecting both hemispheres (vasculitis, atherosclerosis, hypertensive lacunar cerebral infarctions);
traumatic brain injuries;
brain damage due to severe hypoxia;
epileptoform syndrome in children (a single episode of paralysis may occur);
demyelinating disorders;
Pick's disease;
bilateral perisylvian syndrome;
multiple system atrophy;
intrauterine pathology or birth trauma in newborns;
genetic disorders (amyotrophic lateral sclerosis, olivopontocerebellar degenerations, Creutzfeldt-Jakob disease, familial spastic paraplegia, etc.);
Parkinson's disease;
glioma;
neurological conditions after inflammation of the brain and its membranes.

Creutzfeldt-Jakob disease, in which not only pseudobulbar syndrome is observed, but also symptoms of rapidly progressing dementia, is a serious disease, the predisposition to which is genetically determined. It develops due to the entry into the body of abnormal tertiary proteins, similar in their action to viruses. In most cases, death occurs within a year or two from the onset of the disease. There is no treatment to eliminate the cause.

The symptoms that accompany pseudobulbar palsy, like bulbar palsy, are expressed in dysphonia, dysphagia and dysarthria (in a milder version). But these two lesions of the nervous system have differences.

If with bulbar palsy atrophy and degeneration of muscles occurs, then these phenomena are absent with pseudobulbar palsy. Defibrillar reflexes also do not occur.

Pseudobulbar syndrome is characterized by uniform paresis of the facial muscles, which are spastic in nature: disorders of differentiated and voluntary movements are observed.

Since disturbances in pseudobulbar palsy occur above the medulla oblongata, there is no threat to life due to arrest of the respiratory or cardiovascular systems.

The main symptoms that indicate that pseudobulbar palsy has developed, and not bulbar, are expressed in violent crying or laughter, as well as reflexes of oral automatism, which are normally characteristic of children, and in adults indicate the development of pathology. This could be, for example, a proboscis reflex, when the patient stretches out his lips with a tube if light tapping is done near the mouth. The same action is performed by the patient if he brings any object to his lips. Contractions of the facial muscles can be caused by tapping the bridge of the nose or pressing the palm under the thumb.

Pseudobulbar palsy leads to multiple softened foci of the brain substance, so the patient experiences a decrease in motor activity, disorders and weakening of memory and attention, a decrease in intelligence and the development of dementia.

Patients may develop hemiparesis, a condition in which the muscles on one side of the body become paralyzed. Paresis of all limbs may occur.

With severe brain damage, pseudobulbar palsy can appear together with bulbar palsy.

Therapeutic effects

Since pseudobulbar syndrome and bulbar syndrome are secondary diseases, treatment should be aimed at the causes of the underlying disease, if possible. With the weakening of the symptoms of the primary disease, the signs of paralysis can be smoothed out.

The main goal of treatment for severe forms of bulbar palsy is to maintain the vital functions of the body. For this purpose they prescribe:

artificial ventilation;
tube feeding;
prozerin (it is used to restore the swallowing reflex);
atropine for excessive salivation.

After resuscitation measures, comprehensive treatment should be prescribed, which can affect the primary and secondary diseases. Thanks to this, life is preserved and its quality is improved, and the patient’s condition is alleviated.

The issue of treating bulbar and pseudobulbar syndromes through the introduction of stem cells remains controversial: supporters believe that these cells can produce the effect of physical replacement of myelin and restore the functions of neurons, opponents point out that the effectiveness of using stem cells has not been proven and, on the contrary, increases the risk of developing cancerous tumors.

Restoration of reflexes in a newborn begins in the first 2 to 3 weeks of life. In addition to drug treatment, he undergoes massage and physiotherapy, which should have a tonic effect. Doctors give an uncertain prognosis, since complete recovery does not occur even with adequately chosen treatment, and the underlying disease may progress.

Bulbar and pseudobulbar syndrome are severe secondary lesions of the nervous system. Their treatment must be comprehensive and must be aimed at the underlying disease. In severe cases of bulbar palsy, respiratory and cardiac arrest may occur. The prognosis is unclear and depends on the course of the underlying disease.

Bulbar syndrome is a serious neurological disease. The pathology leads to paralysis of the tongue, muscles of the pharynx, and lips. Progressive bulbar palsy poses a risk to human health and is difficult to treat.

The patient may feel that he is having difficulty eating food on his own. You will need to visit a medical facility as soon as the first symptoms appear.

If you ignore the signs, there will be irreversible consequences. Bulbar syndrome is a dangerous disease and must be treated promptly.

The bulbar nerves are affected due to neurological development. This leads to changes in the central nervous system. When motor nerve endings are affected, peripheral paralysis occurs.

The following causes of bulbar syndrome are observed:

, due to which the medulla oblongata was affected;
infectious head disease;
malignant and benign tumor processes;
bruises and fractures of the base of the skull;
inflammation in the brain;
botulinum toxin intoxication.

It often happens that the cause of bulbar palsy is hypertension. The disease worsens the patient's condition over time. Against this background, atherosclerosis develops, vascular spasm occurs, and this leads to a stroke, which is why bulbar syndrome occurs.

If you feel unwell, you should consult a doctor. If bulbar symptoms are ignored, various complications can occur.

Symptoms

There are several types of bulbar syndrome. The acute form of the pathology passes quickly and develops against the background of a stroke, swelling or contusion of the brain, or encephalitis. If the disease is progressive, then bulbar palsy occurs slowly.

It occurs against the background of various pathologies that are associated with the central nervous system. Most often this is Kennedy amyatrophy, tumor formations in the brain. Bulbar syndrome can be bilateral or unilateral. The pathology is often reflected in the movements of the larynx, tongue, and pharynx.

There are three signs that appear with bulbar palsy:

Dysphagia– this is when swallowing is impaired. The patient has difficulty swallowing food due to progressive paralysis of the soft palate. A weak patient may easily choke on food. Over time, progressive bulbar palsy develops, and the patient has difficulty eating even soft foods.
Dysarthria. There is a violation of the pronunciation of words. At first, the patient can make sounds, but bulbar palsy leads to a complete absence of speech.
Dysphonia leads to impaired vocal functions. A person observes how hoarseness and hoarseness develop.

A patient with bulbar palsy may be affected by facial expressions and facial expressions. The mouth may be open and saliva will be released. When eating, food may fall out of the mouth. Bulbar syndrome can lead to serious consequences in the form of disorders of the respiratory and cardiovascular systems.

The patient experiences changes in the oral cavity. The tongue becomes uneven, folded and twitches at times. If the patient has unilateral bulbar syndrome, then the changes will be on one side. With bilateral lesions, the tongue may be completely immobile.

When changes occur in the hypoglossal nerve ending, saliva begins to be released heavily. Many patients may suffer from severe salivation, so they use a handkerchief on a regular basis. At the first manifestations of bulbar syndrome, it is necessary to visit a specialist.

Diagnostics

A neurologist prescribes diagnosis and treatment of bulbar palsy. First of all, the specialist conducts a neurological examination and electromyography. Based on the diagnostic results, the doctor identifies the cause of bulbar syndrome and prescribes treatment. The specialist must determine the breathing rate and heartbeat.

The following studies are carried out for bulbar palsy:

Radiography makes it possible to detect fractures and bruises of the head, and tumor processes.

Electromyography helps check the performance of the muscles of the tongue, neck, arms, and legs. This type of diagnosis reveals muscle activity in a calm state and during contraction.
Esophagoscopy. This research method helps to examine the esophagus. The performance of the pharynx muscles and vocal cords is assessed.

Magnetic resonance imaging. A fast and high-quality diagnostic method that detects various diseases in 90% of cases. MRI makes it possible to evaluate the condition of all organs. Tomography helps identify brain pathologies. The study is most often carried out using a contrast agent.
Electrocardiogram. Makes it possible to find different heart diseases and study heart rhythm.

Laboratory tests are carried out to identify inflammatory processes, infections, and hemorrhage. A general analysis of urine, blood and cerebrospinal fluid examination is prescribed.

When performing computed tomography and MRI, tumor formations, edema, and cysts are detected in the brain. If the first symptoms of bulbar palsy appear, you should immediately visit a doctor. The disease only progresses over time and cannot be avoided without treatment. the disease can be fatal.

Bulbar palsy in children

Bulbar palsy develops in unborn children. There is strong moisture in the oral mucosa; in normal conditions it should be almost dry. If you examine the baby's mouth when he is crying, you will notice that the tongue is slightly turned to the side. This sign appears when the hypoglossal nerve ending is disrupted.

Bulbar syndrome in children occurs in rare cases, as it involves damage to the brain stems. They cease to function, and life without them is impossible. Pseudobulbar palsy often occurs in children and is extremely difficult. The baby suffers not only from loss of speech, but also from changes in muscle tone.

Hyperkinesis and various disorders of the motor system may also develop. This leads to cerebral palsy. The disease can begin to affect newborns and children under two years of age. Most often, cerebral palsy occurs due to birth injuries.

With bulbar syndrome, the child experiences impaired motor skills. It happens that the upper facial part is damaged, which causes immobility. The child does not have the opportunity to take care of himself. Such children look clumsy, have difficulty chewing and swallowing food, and keep drool in their mouth. Proper treatment for bulbar palsy must be prescribed.

Treatment

If the patient acute form of bulbar palsy, then medical assistance must be provided in a timely manner. Therapy will be aimed at eliminating complications of the pathology. First of all, the patient is connected to a ventilator. This is necessary in order to maintain the patient’s vitality and restore breathing during bulbar syndrome.

Prozerin, Adenosine triphosphate, vitamins are used, they help activate swallowing reflexes and improve gastric motility. By regulating swallowing, the production of gastric juice and saliva is reduced. The patient is given an atropine drip. The drug is available in various forms, but since the patient has a violation of the swallowing reflex, the medicine is administered intravenously.

Eating through a tube. This feeding method makes it possible to avoid food entering the respiratory system. If a person is in a comatose state, then he is given nutrients and glucose by dropper. Patients suffering from bulbar palsy are sensitive, irritable, and depressed.

It happens that many patients may refuse to eat because they are afraid of choking. Such patients are referred for treatment to a psychotherapist. Drug therapy for bulbar syndrome is also prescribed.

Medicines

The following medications are used to treat pathology:

Prozerin is prescribed to restore muscle performance. Helps improve swallowing functions and gastric motility. If you have high blood pressure, the drug lowers it.
Atropine is used for severe salivation.
Antibiotics are prescribed if there are infectious diseases.
Torsemide and Furosemide are decongestant diuretics that are needed to relieve swelling in the head.
Parmidine, Alprostan are used for various diseases of the vascular system.
Vitamins B, Neuromultivit, Milgamma, Vitagamma, they are prescribed to support and restore the central nervous system.
Products with glutamic acid improve the metabolic process in the nervous system.

All medications must be taken after they are prescribed by a doctor. Some medications have a number of contraindications and side effects. Self-medication is not recommended, as it can only worsen the patient’s condition with bulbar palsy. Special nutrition must be present, since with an advanced disease the patient cannot eat food on his own.

The patient only feeds through a nasogastric or gastric feeding tube, and a special mixture passes through it. The doctor must show how to properly feed a patient at home with bulbar palsy. The specialist selects the necessary diet to provide the patient with all the necessary vitamins for a speedy recovery.

The food is given liquid, without lumps or solid pieces. As a rule, products are used that have a homogeneous mass and easily pass through a special tube. Nutrizon is available in the form of powder and ready-made drink. This drug contains all the necessary proteins, fats, carbohydrates, vitamins, and microelements.

The patient's feeding tube can be used for about five days. Then it is replaced or washed and treated well. Syringes that are necessary for administering food should be cleaned immediately after feeding.

Traditional methods of treatment

You can combine traditional medicine with drug therapy. There are many prescriptions for the treatment of progressive bulbar palsy. The medicinal mixture is prepared on the basis of white mistletoe, valerian root, oregano, and yarrow. To prepare the tincture, take all the listed plants in equal quantities and pour boiling water over them. You need to use the herbal remedy three times a day, one hundred grams before meals.

The following recipe is prepared from mint, oregano, mistletoe, motherwort, thyme, and lemon balm. You need to mix everything together and add hot water. Wait until it cools down and strain the contents. A remedy for the treatment of bulbar palsy is taken orally, one hundred grams after meals.
Alcohol tincture based on peony root. To prepare, you need to grate the plant and add alcohol one to ten. Place the tincture in a warm place for seven days; as soon as it is ready, strain it. You need to take 35 drops three times a day before eating.

To make a sage tincture, take the plant and pour boiling water over it. Place in a warm place for eight hours. Strain and consume a tablespoon several times a day after meals. You can take medicinal baths from sage and rose hips for bulbar syndrome. Take about 300 grams of the plant, fill it with water and set it to cook for 15 minutes. Let it sit for about an hour, strain the product and pour it into the bath. The procedure should last at least thirty minutes. In order to achieve an effect in the treatment of bulbar palsy, you need to take a bath a couple of times a week.

You need to take fresh tanning sumac leaves and add hot water. Place in a warm place for an hour and strain the product. You need to take a tablespoon about three times a day. If you use traditional methods of treatment correctly, this will help reduce bulbar palsy. Before use, you should consult your doctor.

Progressive bulbar palsy is very dangerous if left untreated. At the first symptoms, you must contact a medical facility. A neurologist will conduct an examination and prescribe a comprehensive diagnosis.

Bulbar syndrome is a disorder accompanied by simultaneous failure of the function of several nerves - glossopharyngeal, sublingual and vagus. This leads to disruption of the processes of chewing and swallowing, and speech dysfunction. Among the dangerous consequences of the pathology are changes in the functioning of the heart and respiratory system. Treatment of bulbar syndrome is based both on the use of various groups of drugs and on surgical interventions. The prognosis for the disease is usually cautious. The outcome depends on the etiology of the lesion.

Causes of development of bulbar syndrome

Many unfavorable factors can provoke disruptions in the functioning of the nervous system and reflex arc. These include both infectious agents and non-infectious pathologies. The main causes of bulbar syndrome in children and adults are:

Congenital genetic abnormalities. A number of diseases are accompanied by damage to the normal structure and functions of the medulla oblongata, which leads to the appearance of specific symptoms of the lesion. Amyotrophy Kennedy and porphyrin disease can provoke the occurrence of such disorders. Pseudobulbar syndrome in children, often noted against the background of cerebral palsy, is also one of the hereditary pathologies. The peculiarity of the problem is the absence of atrophy of the affected muscles, that is, the paralysis is peripheral.
A common cause of bulbar syndrome in newborns is bacterial and viral infections. They lead to inflammation of the membranes of the brain and spinal cord. Meningitis and encephalitis are accompanied by the formation of paralysis, both central and peripheral. Common agents leading to the disorder are Lyme disease and botulism.
Neurology describes the occurrence of bulbar and pseudobulbar syndromes against the background of defects in bone structures, for example, due to injuries or osteochondrosis affecting the neck area. The mechanism of formation of clinical signs is associated with compression of nerve structures, which prevents their normal functioning.
Disorders of the central nervous system also arise during the formation of oncological processes. Tumors prevent adequate nutrition and blood supply to the affected organs, which leads to the formation of problems.
Vascular defects are a common cause of bulbar syndrome. Characteristic disturbances in the functioning of the muscles of the tongue and pharynx occur as a result of a stroke, since with this problem there is a severe degree of ischemia of the nervous tissue. Congenital anomalies in the structure of arteries and veins can also lead to the formation of the disease.
Autoimmune problems are included in a separate group of etiological factors that provoke the occurrence of bulbar syndrome. A common cause of nervous system disorders is multiple sclerosis, which is accompanied by damage to the membranes of the fibers that form the spinal cord and brain.

Main symptoms of pathology

Bulbar syndrome has specific clinical manifestations. Classic signs include:

Changes in facial expressions in patients. The facial muscles atrophy, which leads to the formation of characteristic symptoms. Patients appear emotionless.
Due to damage to the glossopharyngeal nerve, the swallowing process is disrupted. Patients have difficulty chewing food and can easily choke.
There is abundant salivation, which occurs due to pathological changes in the functioning of the vagus. The inhibitory effect of the vagus nerve weakens, which leads to active secretion of the secretion of the digestive glands. Due to the paralysis of several structures at once, it is difficult for the patient to completely close his jaws, so saliva may flow out of the corners of the mouth.
Damage to the hypoglossal nerve provokes severe speech disorders. Patients find it difficult to speak because the muscles are weakened. Pronounced sounds are slurred and drawn out. Similar problems are diagnosed in both adult patients and children.
The most dangerous symptoms of bulbar syndrome are associated with a violation of automaticity in the functioning of vital systems. Patients with the disease suffer from changes in heart function and respiratory failure. Respiratory problems are exacerbated by the high risk of aspiration. In severe cases, apnea is observed, requiring emergency medical attention.

Necessary diagnostic tests

Bulbar syndrome is not an independent disease. Therefore, confirming the presence of a problem comes down to identifying the cause of its occurrence, as well as establishing the nature of the pathological disorders. For this purpose, standard diagnostic tests are carried out - blood, urine and stool tests, as well as a general examination of the patient and medical history.

In many cases, the use of visual methods is required, in particular, magnetic resonance imaging, which makes it possible to detect the presence of tumor and ischemic processes in the cranial cavity. Electromyography, used to differentiate central and peripheral paralysis, is also informative.

Therapy methods

Treatment of bulbar syndrome should be aimed at the cause of its occurrence. In this case, patients often require emergency care, especially against the background of acute cardiac and respiratory failure. Therapy is also symptomatic in nature and is aimed at improving the general condition of the patient. Both conservative methods, traditional and folk, and radical ones are used.

Drug treatment

When an infectious agent that triggers the development of symptoms is identified, antibacterial drugs of various groups are used.
To reduce the intensity of inflammatory processes in injuries, as well as as a palliative treatment of pseudobulbar syndrome in oncology, hormonal agents are used, for example, Prednisolone and Solu-Medrol.
In order to restore the function of autonomic innervation, Atropine is prescribed. It helps reduce the active secretion of saliva and also prevents bradycardia.
In a number of emergency conditions associated with the development of severe arrhythmia, the use of Lidocaine, which is administered to patients intravenously, is justified.

Physiotherapy

Massage has a pronounced effect in bulbar syndrome. It helps relax muscles and restore normal blood supply to the affected area. Kinesiotherapy improves trophism and the functioning of the nervous system, that is, special training that has positive reviews. Exercises are used to help restore the functioning of the facial muscles. Gymnastics is also used to improve the function of the muscles involved in the swallowing process.

Once the patient's condition has stabilized, work with a speech therapist will be required. It is necessary for the correction of established speech disorders. Electrophoresis with Hydrocortisone and Lidocaine has a pronounced therapeutic effect during rehabilitation after brain damage, for example, as a result of a stroke.

Surgery

In some cases, the use of more radical methods is required. They are used both to alleviate the condition of patients and to influence the cause of the disease. Some patients have a tracheostomy installed to maintain adequate breathing. Many also require a nasogastric tube. Surgical intervention is necessary for patients with operable tumors in the cranial cavity, as well as for those injured as a result of various injuries.

In many cases, treatment is only symptomatic. No exact protocols have been developed to combat bulbar syndrome, since therapy is aimed at the cause of the disease. At the same time, there are recommendations that are used in most European countries to alleviate the condition of patients with amyotrophic lateral sclerosis. The same principles can be used to treat bulbar syndrome:

Medications that help relieve spasms, as well as anticonvulsants that provide relaxation of the affected muscles, are widely used.
The use of heat and water helps to improve the well-being of patients.
Moderate physical activity is also important. In this case, it is recommended to use both general exercises and special ones aimed at training the affected muscle groups.
To maintain adequate body weight, as well as meet the body's nutritional needs, you will need to consult a doctor to create the right diet.
Classes with a speech therapist, both group and individual, are used not only for the purpose of correcting speech dysfunctions. They also contribute to the social rehabilitation of patients, which greatly facilitates the further treatment process.

Nutritional Features

In many cases, patients with bulbar syndrome cannot eat normally. For this purpose, a special tube is installed through which food is supplied. Such features require the use of liquid products. The diet should be balanced and provide adequate nutrition for the body.

Prognosis and possible complications

The outcome of the lesion largely depends on the cause of the disease. Timely provision of medical care is also important, although even with adequate therapy it is not always possible to cure the disease. Moreover, the prognosis for pseudobulbar syndrome is much better, since the pathology is not accompanied by dysfunction of vital organs.

The greatest danger in the disorder is cardiac and respiratory failure. Patients often die due to severe arrhythmia, aspiration pneumonia, and asphyxia when food enters the respiratory tract.

Prevention

Preventing the development of the problem is based on preventing the occurrence of infections and non-communicable diseases that can lead to the formation of pathology. To do this, it is important to lead a healthy lifestyle, as well as regularly undergo preventive examinations with doctors.

Bulbar syndrome, or, as it is also called, bulbar palsy, is a disease caused by changes in activity or damage to certain parts of the brain, causing disruption of the functioning of the organs of the mouth or pharynx.

This is paralysis of the organs of direct food intake or speech, in which the lips, palate, pharynx (upper part of the esophagus, tongue, small uvula, lower jaw) are paralyzed. This disease can be bilateral or unilateral, affecting half of the pharynx in a longitudinal section.

The following symptoms are observed with the disease:

Lack of facial expressions of the mouth: the patient simply cannot use it.
Constantly open mouth.
Entry of liquid food into the nasopharynx or trachea.
There are no palatal and pharyngeal reflexes; a person stops involuntarily swallowing, including saliva).
Due to the previous symptom, drooling develops.
If one-sided paralysis occurs, the soft palate hangs down, and the uvula is pulled to the healthy side.
Slurred speech.
Inability to swallow
Paralysis of the tongue, which may constantly twitch or be in an outward position, hanging out of the mouth.
Breathing is impaired.
There is a deterioration in heart activity.
The voice disappears or becomes dull and barely audible, changes its tone and becomes completely different from the previous one.

Patients are often unable to swallow, so they are forced to eat liquid food through a tube.

In medicine, a distinction is made between bulbar and pseudobulbar syndromes, which have very similar symptoms, but are still slightly different, have different causes, although they are related in origin.

During pseudobulbar palsy, the palatal and pharyngeal reflexes are preserved, and tongue paralysis does not occur, but swallowing impairment still develops; most patients show symptoms of forced laughter or crying when touching the palate.

Both paralysis occurs as a result of damage to the same parts of the brain for the same reasons, but bulbar syndrome develops due to damage to the brain nuclei responsible for the functions of swallowing, heartbeat, speech or breathing, and pseudobulbar syndrome develops from damage to the subcortical pathways from these nuclei to the nerves bulbar group responsible for these functions.

At the same time, pseudobulbar syndrome is a less dangerous pathology that does not entail the risk of sudden cardiac or respiratory arrest.

What causes the symptoms

Symptoms of the pathology are caused by damage to an entire group of brain organs, specifically the nuclei of several nerves located in the medulla oblongata, their intracranial or external roots. With bulbar syndrome, damage to any one nucleus almost never occurs with the loss of only one function, since these organs are located very close to each other and also have a very small size, which is why they are affected simultaneously.

Due to the lesion, the nervous system loses connection with the organs of the pharynx and can no longer control them either consciously or unconsciously at the level of reflexes (when a person automatically swallows saliva).

A person has 12 pairs of cranial nerves, which appear in the second month of prenatal life, which consist of brain matter and are located in the very center of the brain between its hemispheres. They are responsible for the human senses and the functioning of the face as a whole. At the same time, they have motor, sensory function, or both at once.

The nerve nuclei are unique command posts: ternary, facial, glossopharyngeal, hypoglossal, etc. Each nerve is paired, so their nuclei, which are located symmetrically relative to the medulla oblongata, are also paired. In bulbar syndrome, the nuclei responsible for the glossopharyngeal, hypoglossal or vagus nerve are affected, which has mixed functions in innervating the pharynx, soft palate, larynx, esophagus, and has a parasympathetic effect (exciting and contracting) on the stomach, lungs, heart, intestines, pancreas, responsible for the sensitivity of the mucous membrane of the lower jaw, pharynx, larynx, part of the auditory canal, eardrum and other less important parts of the body. Since the nuclei are paired, they can be damaged either completely or only half of them, located on one side of the medulla oblongata.

Impairment or damage to the vagus nerve in bulbar palsy can cause a sudden stop in the contractions of the heart, respiratory system, or disruption of the gastrointestinal tract.

Causes of the disease

Brain disorders that cause bulbar syndrome can have a huge number of causes, which can be grouped into several general groups:

Hereditary abnormalities, mutations and organ changes.
Brain diseases, both traumatic and infectious.
Other infectious diseases.
Toxic poisoning.
Vascular changes and tumors.
Degenerative changes in brain and nerve tissue.
Bone abnormalities.
Disorders of intrauterine development.
Autoimmune disorders.

Each group contains a large number of individual diseases, each of which can cause complications on the bulbar group of nuclei of the brain and on its other parts.

Bulbar palsy in children

In newborns, bulbar palsy is very difficult to determine; it is diagnosed according to two criteria:

Too high humidity in the mucous membrane of the baby's mouth, which in infants is almost dry.
Retract the tip of the tongue to the side if the hypoglossal nerve is affected.

Bulbar syndrome in children is extremely rare, since all brain stems are affected, which is fatal. Such babies simply die immediately. But pseudobulbar syndrome in children is common and is a type of cerebral palsy.

Treatment methods

Bulbar palsy and pseudobulbar syndromes are diagnosed using the following methods:

General urine and blood tests.
Electromyogram is a study of nerve conduction in the muscles of the face and neck.
Tomography of the brain.
Examination by an ophthalmologist.
Esophagoscopy is an examination of the esophagus with a probe and a video camera.
Analysis of cerebrospinal fluid - brain fluid.
Tests for myasthenia gravis is an autoimmune disease characterized by extreme fatigue of striated muscles. Autoimmune diseases are disorders in which one’s own enraged immune system begins to kill.

Treatment methods and the possibility of complete recovery from bulbar or pseudobulbar palsy depend on the exact cause of their occurrence, since it is a consequence of other diseases. Sometimes it is possible to restore completely all functions, for example, if the disease was not caused by complete damage, but only by irritation of the brain due to infection, but more often during treatment the main goal is to restore vital functions: breathing, heartbeat and the ability to digest food, and it is also possible smooth out the symptoms somewhat.