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Bulbar Signs and Symptoms 01

Topic: Adult

Created on Sunday, September 28 2008 by jdmiles

Last modified on Sunday, September 28 2008.

A patient presents with dysphagia and dysarthria. The tongue shows atrophy and fasciculations. Sensation and gag are intact. The jaw-jerk reflex is very brisk. Of the following, which is the best description of these findings?

 
        A) Bulbar palsy
 
        B) Progressive bulbar palsy
 
        C) Glossopharyngeal palsy
 
        D) Pseudobulbar palsy
 
        E) Hypoglossal palsy
 

 


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This question was created on September 28, 2008 by jdmiles.
This question was last modified on September 28, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Bulbar palsy

This answer is incorrect.


Bulbar palsy refers to dysarthria, dysphagia, and labio-palatal-glosso-pharyngeal weakness due to damage to the lower motor neurons of the bulb (medulla). These nerves are CN IX, CN X, CN XI, and CN XII. The brisk jaw-jerk and intact gag in this case implicates damage to upper, not lower motor neurons. Thus, this would be a pseudobulbar palsy.  (See References)

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B) Progressive bulbar palsy

This answer is incorrect.


Bulbar palsy refers to dysarthria, dysphagia, and labio-palatal-glosso-pharyngeal weakness due to damage to the lower motor neurons of the bulb (medulla). These nerves are CN IX, CN X, CN XI, and CN XII. The brisk jaw-jerk and intact gag in this case implicates damage to upper, not lower motor neurons, making this a pseudobulbar palsy. Progressive bulbar palsy is a disease of motor neurons that presents with - you guessed it - a progressive course of bublar palsy. No such progressive course has been described in this case.  (See References)

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C) Glossopharyngeal palsy

This answer is incorrect.


The presence of a brisk jaw-jerk reflex and atrophied tongue suggests that there is more going on here than an isolated Glossopharyngeal palsy.  (See References)

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D) Pseudobulbar palsy

This answer is correct.


Bulbar palsy refers to dysarthria, dysphagia, and labio-palatal-glosso-pharyngeal weakness due to damage to the lower motor neurons of the bulb (medulla). These nerves are CN IX, CN X, CN XI, and CN XII. The brisk jaw-jerk and intact gag in this case implicates damage to upper, not lower motor neurons. The lesion exists rostral to the medulla, e.g., in the cortex. Thus, this would be a pseudobulbar palsy.  (See References)

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E) Hypoglossal palsy

This answer is incorrect.


The presence of a brisk jaw-jerk reflex suggests that there is more going on here than an isolated Hypoglossal palsy.  (See References)

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References:

1. Rowland, L.P. (Ed) (2000). Merritt's Neurology, 10th Edition. Lippincott Williams & Wilkins, Philadelphia. (ISBN:0683304747)Advertising:
2. Malcolm Parsons, Michael Johnson. Diagnosis in colour: neurology. Edinburgh ; Mosby, 2001. (ISBN:0723431795)Advertising:
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adult
Bulbar Signs and Symptoms 01
Question ID: 092808189
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 09/28/2008
Modified: 09/28/2008
Estimated Permutations: 120

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