Pseudobulbar Palsy vs Bulbar Palsy

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Raina

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Hi,

I was wondering if anyone knew the difference between Pseudobulbar Palsy and Bulbar Palsy. I know they are both upper motor neurone disorders. I have done a lot of reading on the net, and as far as I can see they are pretty much the same thing.

Thanks
Raina
 

cpulord1

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Hi Raina,
I am a medical student, and I just joined these forums to answer your question as I was browsing for ALS information lol

the difference is actually that one is upper motor(pseudo), while the other is lower motor(bulbar). Due to this difference, there are clinical differences as well.
For example, bulbar palsy will have an absent gag reflex as it is LMN and therefore affects the cranial nerves itself, while pseudobulbar will have a brisk reflex (UMN lesions generally give a hyperrefelxive response).
Speech will be slurred and tongue will be contracted with UMN
while speech is husky and tongue will have wasting with LMN

Hope this helps!
 

Geo

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OK so what seperates PLS from Pseudo Bulbar Palsey, Especially when a PLSer has Bulbar Symptoms ,are they then PseudoBulbar ,then turning to PLS with Bulbar Symptoms? . My tongue is not contracted so to speak ,but i have Facial and Pharyngeal Muscle Dysfunction . I. E Slurred or slow speech and Mastication issues with chewing the cheeks and or tongue or lips and incoordination with Lower body when walking
or Ataxia . Some PLSers have what they think is Muscle Atrophy ,I personally do not agree . if one has true Atrophy then ,this means true loss of Muscle tissues . when its only a Muscle Dysfunction caused by a UMN Dysfunction ,which in turn causes the muscle or Muscles to Dysfunction when its called upon to work . Geo a PLSer
 

Jennifer51

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Hi Raina,
I am a medical student, and I just joined these forums to answer your question as I was browsing for ALS information lol

the difference is actually that one is upper motor(pseudo), while the other is lower motor(bulbar). Due to this difference, there are clinical differences as well.
For example, bulbar palsy will have an absent gag reflex as it is LMN and therefore affects the cranial nerves itself, while pseudobulbar will have a brisk reflex (UMN lesions generally give a hyperrefelxive response).
Speech will be slurred and tongue will be contracted with UMN
while speech is husky and tongue will have wasting with LMN

Hope this helps!
I too am confused, I have been told I have pseudo bulbar (diagnosed 3 months ago, symptoms only started slightly 6 months ago)
Slurred speach, difficulty swallowing liquids, VERY tired jaw sometimes when eating. And now my legs are getting weaker, especially when trying to walk even small hills or stairs...Lots of cramps and twitching ALL over. I am trying to excercise to keep mobile and am not giving in to it... I have been much better since taking Riluzole...an immediate affect, within hours of taking the first pill..... so what is it with UPPER neurons and lower neurons. Maybe I am being totally silly, but I just dont get the difference...can someone tell me in simple terms
Jennifer 51
 

BethU

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[QUOTE=cpulord1;42196]Hi Raina,
. . . the difference is actually that one is upper motor(pseudo), while the other is lower motor(bulbar). Due to this difference, there are clinical differences as well.
For example, bulbar palsy will have an absent gag reflex as it is LMN and therefore affects the cranial nerves itself, while pseudobulbar will have a brisk reflex (UMN lesions generally give a hyperrefelxive response).
Speech will be slurred and tongue will be contracted with UMN
while speech is husky and tongue will have wasting with LMN

Hope this helps![/QUOTE]


I'm confused, too, but have been embarrassed to admit on the forum that I don't get the difference! :)

I have a "very lively" gag reflex, as described by one neuro, and other reflexes are way over the top now too. (If my husband walks up behind me and says something, I jump 5' in the air!) So that's UMN, and pseudobulbar.

But while my speech is very slurred (UMN), my voice is husky -- this comes and goes -- or nasal at times, and my tongue appears to be very atrophied. (LMN) I'm not sure what a contracted tongue would look like.

One of these days I'll get it straight! I do know (I think I know) that both LMN and UMN issues have to be present for a diagnosed of ALS. And I guess that's all I need to know!
BethU
 

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Hi Raina,

There is a lot of difference between bulbar and pseudobulbar palsy. Let me list them hereunder.

1. Pseudobulbar palsy is an upper motor neuron type of lesion affecting the corticobulbar fibres, that is, fibres connecting cerebral cortex to cranial nerve nuclei in the bulb aka medulla. So in such a lesion features are mainly of the UMN type. Jaw jerk is exaggerated, gag reflex is present, tongue is spastic with a pointed tip. There is emotional lability and patient often has uncontrollable bouts of laughter and crying. Other features are just like bulbar palsy, e.g., dysphagia, dysarthria, nasal intonation of voice, nasal regurgitation while drinking liquids etc.

2. Coming to bulbar palsy, bulb means medulla. Any lesion affecting cranial nerve nuclei in the bulb or medulla leads to bulbar palsy. Symptoms are just like in the pseudobulbar case: dysphagia, dysarthria, nasal intonation, nasal regurgitation. Salient differences are jaw jerk absent, gag reflex absent, tongue is flaccid with a rounded tip sometimes showing fasciculations. No emotional lability..basically it is a LMN type of lesion..
Thank you for the question.
Hope this helps.
References: Richard S Snell's text book of Neuroanatomy
Bedside Clinics In Medicine, Arup Kumar Kundu (Academic Publishers )
 

[email protected]

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Hi Raina,

There is a lot of difference between bulbar and pseudobulbar palsy. Let me list them hereunder.

1. Pseudobulbar palsy is an upper motor neuron type of lesion affecting the corticobulbar fibres, that is, fibres connecting cerebral cortex to cranial nerve nuclei in the bulb aka medulla. So in such a lesion features are mainly of the UMN type. Jaw jerk is exaggerated, gag reflex is present, tongue is spastic with a pointed tip. There is emotional lability and patient often has uncontrollable bouts of laughter and crying. Other features are just like bulbar palsy, e.g., dysphagia, dysarthria, nasal intonation of voice, nasal regurgitation while drinking liquids etc.

2. Coming to bulbar palsy, bulb means medulla. Any lesion affecting cranial nerve nuclei in the bulb or medulla leads to bulbar palsy. Symptoms are just like in the pseudobulbar case: dysphagia, dysarthria, nasal intonation, nasal regurgitation. Salient differences are jaw jerk absent, gag reflex absent, tongue is flaccid with a rounded tip sometimes showing fasciculations. No emotional lability..basically it is a LMN type of lesion..
Thank you for the question.
Hope this helps.
References: Richard S Snell's text book of Neuroanatomy
Bedside Clinics In Medicine, Arup Kumar Kundu (Academic Publishers )
Please excuse the fact that I forgot to add certain pertinent examples in my just-posted response. Here they are:
poliomyelitis (respiratory type) and syringobulbia - bulbar palsy
head injuries, brain ischaemia, ALS, progressive pseudobulbar type of MND - pseudobulbar palsy.
 

flower

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hello everyone I have sym of both but not all of just one, iam just weird I guess but does it matter I still have ALS .
 
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