Pseudobulbar palsy

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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84 Pseudobulbar palsy

Instruction

Examine this patient’s cranial nerves.

Salient features

History

• Ask the patient whether there is difficulty in swallowing or nasal regurgitation

• Any changes in speech

• Emotional lability

• History of stroke, multiple sclerosis or motor neuron disease.

Examination

• Spastic tongue

• Donald Duck speech

• Patient is emotionally labile (uncontrollable laughter, crying, irritability or anger)

• Sluggish movements of the palate when the patient is asked to say ‘aah’.

Proceed as follows:

• Check the jaw jerk

• Tell the examiner that you would like to do the following:

• Check the gag reflex
• Look for upper motor neuron signs in the limbs.

Diagnosis

This patient has pseudobulbar palsy (lesion) caused by a stroke (aetiology); he has difficulty in swallowing and emotional lability (functional status).

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