Bulbar palsy

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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85 Bulbar palsy

Instruction

Examine this patient’s cranial nerves.

Ask the patient a few questions.

Test this patient’s speech.

Salient features

History

• Ask the patient about nasal regurgitation, dysphagia

• Slurring of speech (patient may sound as if they have been intoxicated)

• Difficulty in chewing and swallowing

• Choking on liquids.

Examination

• Nasal speech lacking in modulation and great difficulty with all consonants

• Wasting of the tongue with fasciculations (see Fig. 69.1)

• Weakness of the soft palate: ask the patient to say ‘aah’

• There may be accumulation of the saliva

• Fasciculation elsewhere (particularly trunk muscles).

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