pseudobulbar palsy (spastic bulbar palsy, supranuclear palsy)

Introduction

A syndrome characterized by involuntary laughter & crying. Emotional expression may be at variance with mood.

Pathology

• bilateral lesions in the descending corticobulbar tracts
  • generally secondary to vascular disease (stroke)
• lesions in the frontothalamopontomedullary tract may affect emotional lability

Clinical manifestations

• involuntary laughter & crying (emotional disinhibition)
• emotional expression may be at variance with their mood
• spastic pseudobulbar paralysis
  • dysarthria
  • dysphagia
  • dysphonia
  • increased gag response
• bilateral facial weakness
  • lower face & tongue weakness
  • extraocular, upper facial, pharyngeal & jaw muscles are generally spared
• upper motor neuron signs
  • spasticity, unless acute
  • incoordination
  • dysdiadochokinesis
• Cheyne-Stokes respirations may be observed
• often occurs in the setting of multiple strokes

Differential diagnosis

• amyotrophic lateral sclerosis
• multiple sclerosis
• later stages of vascular dementia
• traumatic brain injury
• brain stem or skull base tumor

Management

• dextromethorphan 20-30 mg plus 10 mg quinidine BID

More general terms

• syndrome

Additional terms

• bulbar paralysis (palsy)
• corticobulbar tract
• emotional lability; asthenic disorder