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