Clinical features of bulbar palsy

Characteristically, the clinical features of bulbar palsy are:

• atrophy and fasciculations in bulbar muscles:
  • tongue appears wasted and folded; fasciculations are prominent and produce a writhing appearance
  • orbicularis oris is often affected at the same time as the tongue; orbicularis oculi and other facial muscles tend to be affected later and less severely
  • the palate and the extrinsic muscles of the pharynx and larynx are affected after the tongue
  • protrusion of the tongue is weakened and lost
• dysarthria and dysphonia - from paresis of the lips, tongue and palate; nasal speech is typical
• dysphagia - food may regurgitate through the mouth; may be most noticeable with fluids
• jaw jerk and gag reflex are absent

Reference

1. McDermott CJ, Shaw PJ. Diagnosis and management of motor neurone disease. BMJ. 2008 Mar 22;336(7645):658-62