Bulbar palsy

Bulbar palsy is a group of signs and symptoms caused by impaired function of four cranial nerves, the glossopharyngeal, vagus, accessory and hypoglossal nerves, which arise from the medulla oblongata. It results from a lower motor neuron lesion in the medulla or from damage to these nerves outside the brainstem, and botulism can produce it as well. The underlying causes are varied and include genetic, vascular, degenerative, inflammatory, infective, cancerous, toxic and autoimmune conditions. Patients typically have difficulty swallowing and chewing, nasal regurgitation, drooling, slurred nasal speech, a weak or absent gag reflex and tongue wasting. The eye muscles are spared, which separates it from myasthenia gravis, and it is distinguished from pseudobulbar palsy, which arises from upper motor neurons. Intubation is used when the airway is obstructed.