Clinical features of pseudobulbar palsy
The characteristic features of pseudobulbar palsy are:
- apparent weakness of the muscles of mastication - V - and facial expression - VII - presenting with difficulty in chewing and an expressionless face. The jaw jerk is exaggerated.
- spastic dysarthria - husky or gravelly voice
- palatal weakness and difficulty in swallowing - X
- brisk gag reflex - IX, X cranial nerves
- tongue is immobile, pointed and cannot protrude - XII - this should be discriminated from the slow moving tongue seen in Parkinsonian patients
- emotional lability - increased emotions with unprovoked outbursts of laughing or crying
- bilateral limb upper motor neurone signs
Reference
- McDermott CJ, Shaw PJ. Diagnosis and management of motor neurone disease. BMJ. 2008 Mar 22;336(7645):658-62
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