Bulbar syndrome

Dysfunction of cranial nerves which kernels are located in a myelencephalon is called a bulbar syndrome. The main characteristic of a disease is the holoplexia of language, muscles of a throat, lips, an epiglottis, phonatory bands and a soft palate. Quite often disorder of organs of articulation, function of swallowing, chewing and breath is a consequence of a bulbar syndrome (paralysis).

Less expressed degree of paralysis is shown in cases of hemilesion of kernels of IX, X, XI and XII (caudal group) nerves, their trunks and roots in a myelencephalon, however heavy degree of a bulbar syndrome meets at bilateral damage of the same nerves more often.

Pseudobulbar syndrome call the bilateral interruption of cortical and nuclear ways leading to a neurologic syndrome. It is similar to a bulbar syndrome a clinical picture, however has a number of distinctive features and arises because of defeat of other departments and structures of a brain.

Essential distinction between a bulbar and pseudobulbar syndrome is that at the second there is no disturbance of a rhythm of cordial activity, atrophy of the paralyzed muscles, and also an apnoea (apnoea). Often it is followed by unnatural violent laughter and crying of the patient, arising owing to disruption of communication between the central subcrustal nodes and a cerebral cortex. Most often the pseudobulbar syndrome arises at the diffusion damages of a brain having traumatic, vascular, intoksikatsionny or infectious genesis.

Bulbar syndrome: reasons

The list of possible origins of paralysis is quite wide, include genetic, vascular, degenerative and infectious factors in it. So, carry an acute intermittent porphyria and bulbospinalny amyotrophy of Kennedy to the genetic reasons, to degenerative – a syringobulbia, Lyme's disease, poliomyelitis and a syndrome to Giyena-Barra. As the reason of a bulbar syndrome the myelencephalon stroke can also act (ischemic) which is much more often, than other diseases, leads to a lethal outcome.

Development of a bulbar syndrome happens at a side amyotrophic sclerosis, a paroxysmal mioplegiya, spinal amyotrophy of Fatsio-Londe, diphtheritic, postvaccinal and paraneoplastic polyneuropathy, and also owing to a hyperthyroidism.

Rank such diseases and processes in a back cranial pole, a brain and craniospinal area as other probable causes of a bulbar syndrome as:

• Botulism;
• Tumor in a myelencephalon;
• Bone anomalies;
• Syringobulbia;
• Granulematozny diseases;
• Meningitis;
• Encephalitis.

Against the background of a paroxysmal mioplegiya, a myasthenia, a dystrophic myatonia, an okulofaringealny myopathy, Kirnsa-Seyr's syndrome, a psychogenic dysphonia and a dysphagy paralysis can also develop.

Symptoms of a bulbar syndrome

At paralysis patients have problems with consumption of liquid food, often they poperkhivatsya by it, and cannot sometimes reproduce the deglutitory movements because of what from corners of their mouth saliva can flow.

In especially hard cases of a bulbar syndrome there can be a disorder of cardiovascular activity and a respiratory rhythm that is caused by a close arrangement of kernels of cranial nerves of caudal group with the centers of respiratory and cardiovascular systems. Such involvement in pathological process of cordial and respiratory systems quite often leads to a lethal outcome.

Sign of a bulbar syndrome is loss of palatal and pharyngeal reflexes, and also an atrophy of muscles of language. It is the result of defeat of kernels IX and X nerves which are a part of reflex arcs of above-mentioned reflexes.

The most common symptoms of a bulbar syndrome is the following:

• Lack of a mimicry at the patient, he does not manage to swallow, fully to chew food;
• Disturbance of phonation;
• Hit of liquid food after the use in a nasopharynx;
• Disturbance of cardiac performance;
• Twang and indistinctness of the speech;
• In case of a unilateral bulbar syndrome the language deviation on the party which is not affected with paralysis, its twitching, and also droop of a soft palate is observed;
• Breath disturbance;
• Lack of a palatal and gag reflex;
• Pulse arrhythmia.

Paralysis symptoms in each separate case can be various degree of manifestation and complexity.

Diagnosis of a bulbar syndrome

Before starting direct treatment, the doctor has to carry out survey of the patient, in particular area of a stomatopharynx, to reveal all symptoms of a disease, to carry out an electromyography according to which it is possible to define severity of paralysis.

Treatment of a bulbar syndrome

In certain cases preservation of life of the patient at a bulbar syndrome requires preliminary acute management. A main goal of such help is elimination of threat of life of the patient before it is transported in medical institution in which then adequate treatment will be picked up and appointed.

The doctor, depending on clinical symptoms and the nature of pathology, can predict a disease outcome, and also efficiency of alleged treatment of a bulbar syndrome which is carried out in several steps, namely:

• Reanimation, support of those functions of an organism which owing to paralysis were broken – artificial ventilation of the lungs for breath recovery, Prozerin's use, adenosinetriphosphate and vitamins for start of a deglutitory reflex, purpose of Atropine for decrease in hypersalivation;
• Further the symptomatic therapy directed to simplification of a condition of the patient follows;
• Treatment of a disease against the background of which there was a development of a bulbar syndrome.

Feeding of patients with paralysis is carried out enterally, by means of the food probe.

The bulbar syndrome is the disease arising owing to disturbance of work of cranial nerves. Often, even at use of adequate treatment to achieve 100% of recovery of the patient it turns out only in isolated cases, however considerably to improve health of the patient it is quite real.