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). Questions What could be the underlying cause? • Bilateral stroke • Multiple sclerosis • Motor neuron disease. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Wallenberg’s syndrome (lateral medullary syndrome) Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Pseudobulbar palsy Full access? Get Clinical Tree
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). Questions What could be the underlying cause? • Bilateral stroke • Multiple sclerosis • Motor neuron disease. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Wallenberg’s syndrome (lateral medullary syndrome) Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Pseudobulbar palsy Full access? Get Clinical Tree
