Pseudo-bulbar Palsy (PBA), Related Question about PBA

 What is pseudo-bulbar palsy?

Involuntary emotional expression disease, also known as pseudobulbar palsy, is a syndrome that affects your ability to control the muscles in your face (including your jaw). Mouth muscles (such as your tongue) and throat muscles might also be impacted. It has the potential to make a significant impact on your daily life. It can also impair your ability to communicate, consume, and swallow. 

You may also experience uncontrollable sobbing or laughing at inopportune times, in addition to these symptoms. This is known as "emotional incontinence" or "pseudo-bulbar affect."

Pseudo-bulbar palsy is common in Stroke patients and individuals with neurological illnesses such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS).

What are the symptoms of pseudo-bulbar palsy?

If you have pseudo-bulbar palsy, you will have difficulty coordinating your facial muscles, particularly your tongue and several neck muscles involved in speaking and swallowing. You may also notice the following signs and symptoms: 

 

•Dysarthria (slowed or slurred speech).

•Dysphagia (difficulty swallowing) 

lead to longer mealtimes

•Accidental weight loss. 

•Emotional lability; or quick or excessive fluctuations in your mood.

•Dysphonia, or spasms of your vocal cord muscles causing changes in your voice.

 

What causes pseudo-bulbar palsy?

Conditions that alter the nerves that convey information from your cerebral cortex to locations in your lower brain stem are the most common causes of pseudobulbar palsy. Your cerebral cortex is a multi-purpose part of your brain. Controlling your motor functions (such as jumping and talking) and senses is one of them (such as vision, touch, and smell). 

 

The following are the most common causes of pseudo-bulbar palsy: 

 

•Motor neuron disease. 

•Stroke.

•Cerebrovascular disorders.

•Multiple sclerosis.

 

Who is at risk of pseudo-bulbar palsy?

You may be at risk of getting pseudo-bulbar palsy if you've had any of the following conditions:

 

•Motor neuron disease. 

•Stroke.

•Cerebrovascular disorders.

•Multiple sclerosis.

 

How is pseudo-bulbar palsy diagnosed?

Your doctor will need to look at the following to see if you have pseudo-bulbar palsy: 

 

•Face expressions.

•Emotional expression. 

•Speech.

•Pseudo-bulbar palsy is frequently misdiagnosed as severe depressive disorder.

•When the primary symptom is emotional incontinence. 

 

MRI scan of your brain to determine the cause of your symptoms or to rule out an underlying neurologic condition.

 

How is pseudo-bulbar palsy treated?

Pseudo-bulbar palsy has no known treatment, however, your doctor may be able to alleviate some of your symptoms. Medication, rehabilitative treatment, lifestyle changes, including dietary changes, and other therapies may be recommended by your doctor. 

 

Treatment for the underlying cause of your pseudo-bulbar palsy may also be prescribed by your doctor. For example, they might prescribe treatment for stroke, dementia, or motor neuron disease.

 

Promotor exercises, pharyngeal tactile stimulation, tongue retraction exercises, effortful swallowing exercises, the Mendelssohn maneuver (a method of intentionally holding the larynx when the larynx is elevated), and shaker exercises can all help in dysphagia.

Vocal cord adduction exercises and respiration-phonation training can aid with dysarthria speech therapy.

 

Different Question related to Pseudo-bulbar palsy

 

How can you tell the difference between bulbar and pseudo-bulbar palsy?

Bulbar palsy is a lower motor neuron (LMN) lesion of cranial nerves IX, X, and XII.

A pseudo-bulbar palsy is an upper motor neuron (UMN) lesion of cranial nerves IX, X, and XII.

 

What does pseudo-bulbar palsy mean?

Pseudo-bulbar palsy is a syndrome of upper motor neuron (UMN) paralysis that affects the corticobulbar system above the brain stem bilaterally.

 

How is pseudo-bulbar palsy diagnosed?

Diagnosis of pseudo-bulbar palsy is based on observation of the symptoms according to the condition of the patient. Tests examining jaw jerk and gag reflex can also be performed.

 

Can the pseudo-bulbar effect be cured?

There is no cure for pseudo-bulbar affect (PBA), although the condition can be managed by oral medications. The purpose of treatment is to reduce the frequency and severity of episodes of laughing or crying. Drugs that are used to treat PBA include Antidepressants.

 

What medication stops crying?

The medication, Nuedexta, is the first to be approved to treat the patient with symptoms of pseudo-bulbar, or the loss of emotional control.

 

 

 

 

Sixth ( Abducens) Nerve Palsy ( bell's palsy treatment )

Symptoms | Causes | Risk factors | Diagnosis | Treatment

What is sixth nerve palsy?

The sixth nerve palsy is a movement ailment that affects the eyes. Damage to the sixth cranial nerve is the major cause of this palsy. The sixth cranial nerve's main job is to convey impulses to your lateral rectus muscle. 

On the outside of your eye, there is a little muscle called the lateral rectus muscle.Your eye crosses inward toward your nose when the lateral rectus muscle weakens.

 

What are Symptoms of sixth nerve palsy?

Sixth nerve palsy can damage one or both eyes because each eye has its own lateral rectus muscle and sixth cranial nerve. Whether or not both eyes are afflicted determines your symptoms and the severity of the problem. 

The most common sign of sixth nerve palsy is double vision. When both eyes are open or you're looking at something in the distance, you may notice this vision impairment. When staring in the direction of the injured eye, double vision can result. Sixth nerve palsy can also occur without causing double vision.

Poor eye alignment, often known as crossed eyes, is another indication of this illness. When your eyes aren't looking in the same direction at the same moment, you've got this. 

Sixth nerve palsy is characterized by double vision and strabismus. However, you could be experiencing different signs and symptoms. From the brainstem to the lateral rectus muscle, the sixth cranial nerve travels. This suggests that sixth nerve palsy can be caused by neurologic diseases. 

Isolated sixth nerve palsy happens when the sixth nerve palsy occurs without any accompanying symptoms. Other symptoms may indicate that the sixth nerve isn't the only one affected.

 

What are causes sixth nerve palsy?

Sixth nerve palsy can be caused by a variety of factors. It's possible that the ailment is congenital and affects a person from birth. This can happen when the sixth cranial nerve is injured during labour or delivery. However, the etiology of congenital sixth nerve palsy is not always known. 

The disorder can also be caused by a variety of events and illnesses. A head injury or a skull fracture that destroys the sixth cranial nerve is one example of this. Inflammation of the sixth cranial nerve can also cause the condition to manifest. 

Other conditions that might injure or inflame the sixth cranial nerve include: 

 

•Stroke.

•infection.

•Lyme disease is a type of tick-borne illness. 

•A tumor in the brain. 

•Diabetic neuropathy meningitis.

•Aneurysm in the brain caused by multiple sclerosis.

•Trauma, such as a head injury in an accident, is the most prevalent cause of sixth nerve palsy in children. 

•A stroke is the most prevalent cause of death among adults.

 

What are Risk factors for sixth nerve palsy?

Sixth nerve palsy can affect everyone, and there is no specific group of people who are more susceptible to it. You can, however, take precautions to safeguard yourself. Because trauma is a significant cause of concussions, you should exercise caution and protect your head when participating in sports or riding a bicycle. 

You can also take precautions to lower your risk of stroke, which is a common cause of sixth nerve palsy in adults. These are some of the measures: 

 

•High blood pressure management.

•Physical exercise should be increased. 

•Maintaining a healthy diet while reducing weight.

 

How to diagnose sixth nerve palsy?

Consult your doctor if you have double vision or if your eyes aren't aligning properly. Your doctor will ask you questions about your medical history and do a thorough physical examination to determine sixth nerve palsy. 

Because there are several possible causes for sixth nerve palsy, your doctor may request a number of tests. The dysfunction may be gradually corrected if the underlying cause is addressed. These tests include the following: 

 

A brain scan to look for a tumor, a skull fracture, a brain injury, or elevated pressure in the brain.

A lumbar puncture to diagnose or rule out meningitis.

Neurological tests to look for abnormalities in your nervous system.

 

How to treat sixth nerve palsy?

In certain circumstances, such as when the illness is caused by a viral infection that must run its course, therapy is unnecessary and sixth nerve palsy improves with time. In some cases, the disease improves only after the underlying cause is addressed. 

Your treatment will be determined by your diagnosis. If your sixth nerve palsy is caused by a bacterial infection, your doctor may prescribe medications. 

Inflammation-related sixth nerve palsy can be treated with prescription-strength corticosteroids. 

Symptoms of sixth nerve palsy may not improve if you have a brain tumour until you have surgery, chemotherapy, or other therapies to remove the tumor or destroy cancer cells.

You may never fully recover from trauma-induced sixth nerve palsy. Over the course of six months, your doctor may monitor your condition. If your double vision or strabismus doesn't improve or worsens, you can try wearing an eye patch over the problematic eye for a long time. Prism glasses may be recommended by your doctor to offer single binocular vision and align your eyes. 

Some medical methods have also shown to be successful. Botulinum toxin injections (Botox), in which your doctor paralyses the muscles on one side of your eye to correct incorrect alignment, are one of these options. Another alternative is to have your eyes operated on. Surgery can prevent an afflicted eye from pushing inward toward the nose if it is successful.

 

 

Assessment of Cranial Nerves mnemonic, cranial nerves function, cranial nerves test

 

1st Cranial nerve

 

Smell, which is controlled by the 1st (olfactory) cranial nerve, is normally assessed only after a head injury or when lesions of the anterior fossa (e.g., meningioma) are suspected or when patients report irrelevant smell or taste. 

 

While one nostril is closed, the patient is asked to identify smell (such as soap, coffee, or cloves) delivered to each nostril. When malingering is suspected, irritants such as alcohol, ammonia, and other irritants are used to test the nociceptive receptors of the 5th (trigeminal) cranial nerve.

 

2nd Cranial nerve

 

Visual performance is examined for the second (optic) cranial nerve using a Snellen chart for distance vision or a portable chart for near vision; each eye is assessed separately, with the other eye covered. 

Standard pseudoisochromatic Ishihara or Hardy-Rand-Ritter plates with numbers or figures placed in a field of specially colored dots are used to evaluate color perception. 

Direct confrontation is used to examine visual fields in all four visual quadrants. The pupillary responses are assessed both directly and indirectly. In addition, a funduscopic examination is performed.

 

3rd, 4th, and 6th Cranial nerves

 

Eyes are examined for symmetry of movement, globe position, asymmetry or drooping of the eyelids (ptosis), and twitches or flutters of the globes or lids for the 3rd (oculomotor), 4th (trochlear), and 6th (abducens) cranial nerves. The patient is asked to follow a moving target (e.g., examiner's finger, penlight) across all four quadrants (including across the midline) and toward the tip of the nose; this test can reveal nystagmus and ocular muscle palsies. End-lateral gaze nystagmus with a fine amplitude is normal. 

In a dimly light space, anisocoria (Anisocoria is unequal pupil size) in pupillary size should be noted. The symmetry and briskness of the pupillary light response are assessed.

5th Cranial nerve

 

The 3 sensory divisions (ophthalmic, maxillary, and mandibular) of the 5th (trigeminal) nerve are assessed using a pinprick to test facial sensibility and a wisp of cotton against the lower or lateral cornea to assess the corneal reflex. The angle of the jaw should be evaluated if face sensation is gone; sparing of this area (innervated by spinal root C2) suggests a trigeminal deficit. Depressed or absent corneal sensation, which is frequent in contact lens wearers, should be separated from a weak blink due to face weakness (e.g., 7th cranial nerve paralysis). Even if the blink rate is reduced, a patient with facial weakness feels the cotton wisp on both sides normally. 

 

The masseter muscles are palpated as the patient clenches his or her teeth, and the patient is asked to open his or her mouth against opposition. The jaw deviates to that side if a pterygoid muscle is weak.

7th Cranial nerve

 

Hemifacial weakness is used to assess the 7th (facial) cranial nerve. The nasolabial fold is depressed and the palpebral fissure is widened on the weakened side of the face during spontaneous conversation, especially when the patient smiles or, if obtunded, grimaces at a noxious stimulus; on the weakened side, the nasolabial fold is depressed and the palpebral fissure is widened. The etiology of 7th nerve weakness is central rather than peripheral if the patient only displays lower facial weakness (i.e., furrowing of the forehead and eye closure are retained). 

Sweet, sour, salty, and bitter solutions placed with a cotton swab on one side of the tongue, then the other, can be used to assess taste in the anterior two thirds of the tongue. 

 

A vibrating tuning fork held adjacent to the ear can identify hyperacusis ( a disorder in loudness perception)f, which indicates stapedius muscle weakness.

8th Cranial nerve

 

Because the 8th cranial nerve (vestibulocochlear, acoustic, auditory) conveys both auditory and vestibular input, a thorough examination is required. 

 

Hearing evaluations 

Tests of vestibular function 

Hearing is first checked in each ear by whispering something into one ear while occluding the other. Formal audio-logic testing should be performed on any suspected hearing loss to validate findings and distinguish conductive hearing loss from sensorineural hearing loss. To separate the two, the Weber and Rinne tests can be performed at the bedside, although they are difficult to do efficiently outside of specialized facilities. 

 

The presence of nystagmus can be used to assess vestibular function. The existence of nystagmus and its characteristics (such as direction, duration, and triggers) can help detect vestibular diseases and distinguish central from peripheral vertigo. Vestibular nystagmus is made up of two parts: 

Vestibular input causes a sluggish component. 

A quick-acting, reversible component that induces movement in the opposite direction (called beating).

9th and 10th Cranial nerves

 

Typically, the 9th (glossopharyngeal) and 10th (vagus) cranial nerves are assessed simultaneously. It is recorded whether the patient's palate raises symmetrically when he or she says "ah." The uvula is lifted away from the paretic side if one side is paretic. A tongue blade can be used to touch one side of the posterior pharynx, then the other, to see if the gag reflex is symmetrical; bilateral absence of the gag response is frequent among healthy persons and is unlikely to be relevant. 

Suctioning the endotracheal tube generally causes coughing in an intubated, unconscious patient. 

 

The vocal chords are examined if hoarseness is detected. Isolated hoarseness (with normal gag and palate elevation) should initiate a search for lesions compressing the recurrent laryngeal nerve (e.g., mediastinal lymphoma, aortic aneurysm).

11th Cranial nerve

 

The muscles supplied by the 11th (spinal accessory) cranial nerve are tested: 

 

The patient is asked to turn the head against resistance provided by the examiner's hand as the examiner palpates the active muscle for the sternocleidomastoid (opposite the turned head). 

The patient is instructed to raise their shoulders against the examiner's resistance for the upper trapezius.

12th Cranial nerve

 

By asking the patient to extend their tongue and evaluating it for atrophy, fasciculations, and weakness, the 12th (hypoglossal) cranial nerve is assessed (deviation is toward the side of a lesion).