Pseudobulbar Palsy

Pseudobulbar Palsy

Pseudobulbar palsy, or spastic bulbar palsy, describes bilateral upper motor neurone lesions affecting fibers passing to the cranial nerve nuclei (cf. bulbar palsy). This leads to a variety of clinical problems, including:

Difficulty with speech: spastic dysarthria, dysphonia Difficulty with swallowing: dysphagia
Brisk jaw jerk and pout reflex; there may be trismus Slow, spastic, tongue movements
Gag reflex may be depressed or exaggerated.

There may be associated emotional lability, or pathological laughter and crying ("pseudobulbar affect"), and a gait disorder with marche à petit pas. There are otherwise few signs in the limbs, aside from brisk reflexes and upgoing plantar responses (Babinski’s sign).
Recognized causes of pseudobulbar palsy include:

Motor neurone disease (in which there may be coincident bulbar palsy)
Multiple sclerosis
Bilateral internal capsule lacunar infarctions, widespread small vessel disease (Binswanger’s disease)
Congenital childhood suprabulbar palsy (Worster-Drought syndrome; perisylvian syndrome).


Cross References

Babinski’s sign (1); Bulbar palsy; Dysarthria; Dysphagia; Dysphonia; Emotionalism, Emotional lability; Gag reflex; Jaw jerk; Marche à petit pas; Pathological crying, Pathological laughter; Trismus; Upper motor neurone (UMN) syndrome