Thank you so much for this presentation. I am an SLP student and this video helps me very much with the understanding of Flaccid and Spastic dysarthria. Thanks again
Thanks for the question! Muscle twitching, or fasciculations, can occur in any skeletal muscle and are caused by contractions of a muscle group that is served by a single motor nerve fiber. The motor nerve fibers are lower motor neurons, so we associate fasciculations with lower motor neuron lesions. If the lower motor neural control of the skeletal muscle is impaired, fasciculations can result. (continued)
Excellent. My friend developed "progressive bulbar paralysis " after a polio vaxxine in 1959 and was in an iron lung for awhile. Luckily, he recovered 95%.
thank you very much . This is so kind of you. I highly appreciate your kind efftorts. In this part of world, where we don't have access to the medical educational materials, you come to us as a ray of hope. Oncee again thank you very much
Hi, Pseudobulbar palsies are bilateral because of bilateral innervation. Bulbar palsy causes tend to be disease related (muscle or nerve disorders) which would present bilaterally. In the presence of a unilateral bulbar palsy, I would strongly consider a space-occupying lesion/tumor. Best regards, LB
Useful to note the presence of flaccid dysarthria (speech) in people with bulbar palsy, which could include the hypernasal resonance and/or raspy vocal quality you described with weakness of the soft palate.
Hi, I do mention that gag reflex is absent (diminished) and I do note that that the jaw jerk is normal. I believe that your textbook is incorrect in stating that the jaw jerk is absent because of the explanation I give at 7:22: CN V anfd CN VII are exluded in bulbar palsy. I hope this helps!
For further clarification, note that the lower motor neuron structures include the Cranial Nerve XII nuclei which function like the anterior horn cells in the cord. Both house the cell bodies of the peripheral nerves that ensue. The nerve itself is also a lower motor neuron structure, so damage in any of these structures can result in fasciculations. (continued)
Hi. Thanks for the video and resource. Quick question. When you say Cranial nerve XI do you mean CN IX? CN XI, spinal accesory innervates the trapezius muscles and the sternocleidomastoid. CN IX (Glossopharengeal) is involved with swallowing and gag reflex
Hi Sarah, The following is from: Brain (2001) Pathological laughter and crying: A link to the cerebellum. Vol 124, Iss 9, pp1708-1719: The traditional and currently accepted view is that PLC is due to the damage of pathways that arise in the motor areas of the cerebral cortex and descend to the brainstem to inhibit a putative centre for laughter and crying. In that view, the lesions `disinhibit' or `release' the laughter and crying centre...continued
I don’t know if I have Pseudobulbar but I probably don’t cause it triggers when I feel so stressed or when my mom barges in my privacy or when she tells me off and falsely accuses me. When she left the room, my head throbbed on one side and I bent down, randomly tears starting falling and I tried to wipe it off but it kept falling again and then I started laughing while crying. All I could think was how to leave, how to die, how to kill, how to end it all, how to be strong, how to be happy, etc.
The critical PLC lesions occur in the cerebro-ponto-cerebellar pathways. THis is what allows the laughter without humorous context. I hope this helps. LKB
Good video, however The corticospinal tract carries motor signals from the primary motor cortex in the brain, down the spinal cord, to the muscles of the trunk and limbs. ... The corticobulbar tract carries efferent, motor, information from the primary motor cortex to the muscles of the face, head and neck. They are not the same thing.
Hi! Water is not necessary in testing for bulbar palsy, but the patient may complain of fluid finding its way up the nasopharynx when swallowing. The nasal tone of the voice in a bilateral bulbar palsy is due paresis of the soft pallet due to cranial nerve X involvement. As a result, air during speech is allowed to escape through the nose. I hope this is helpful.
Hello dr thank you very much for this video i have a question why there is not an alteration of the upper half of the face despite the bilateral alteration of the supranucleus pathways
The upper motor neuron structures include anything from the motor cortex through the corticobulbar tract prior to synapsing on the nuclei. Damage along this pathway will result in spasticity of the tongue. I hope this is helpful...
Excellent video. Really useful way of explaining these conditions! One question, i have written down in my notes that in End stage multiple sclerosis you will get pseudobulbar palsy (because of demyelination within CNS). However can patients present with pseudobulbar symptoms?
Demyelination of the connections between the primairy motor neuron (in the cortex) and the secundairy motor neuron (in the brain stem). White matter is also bart of the corticobulbair tract :)
Yes, cranial nerve V and VII nuclei are in the brainstem, but are involved in pseudobulbar palsy and not bulbar palsey. Let me know if you need further explanation or if I did not understand your question.
Thank you so much for this great video! But just a quick question... are the same results seen in the SCM and traps as well i.e. spasticity and fasciculations and atrophy or not due to collateral innervation? thank you again! :D
i am not medically trained. My memory fades and i am emmotionally Highly strung. My neuro fails to make a final diagnoses even though they ar "the best" in the area. My situation is apperantly UNIQUE???
pretty much the same thing. in normal people jaw jerk is absent and it's normal. but some people can have slightly present jaw jerk and it still can be normal.
Hello, my name is David. I have been diagnosed with MND Vs MultiFocal motor Nueropathy,I am being treated with IGIV Immunoglobulin, I believe i have MND as I am no responding to the treatment. Symptoms..Fasiculations Face, limbs body and tongue. My Gag reflex was initially over reactive and has dimminished to under active. Forgive my terminoligy,
My mother has been diagnosed with PBP and she exhibits excessive crying and emotional distress that she cannot articulate as to why she is crying. Is this another symptom?
Thank you so much for this presentation. I am an SLP student and this video helps me very much with the understanding of Flaccid and Spastic dysarthria. Thanks again
Thanks for the question! Muscle twitching, or fasciculations, can occur in any skeletal muscle and are caused by contractions of a muscle group that is served by a single motor nerve fiber. The motor nerve fibers are lower motor neurons, so we associate fasciculations with lower motor neuron lesions. If the lower motor neural control of the skeletal muscle is impaired, fasciculations can result.
(continued)
Excellent. My friend developed "progressive bulbar paralysis " after a polio vaxxine in 1959 and was in an iron lung for awhile. Luckily, he recovered 95%.
11 years ago and yet great explanation and presentation
thank you very much . This is so kind of you. I highly appreciate your kind efftorts. In this part of world, where we don't have access to the medical educational materials, you come to us as a ray of hope. Oncee again thank you very much
fantastic and straight to the point
Glad the video was helpful!
Hi,
Pseudobulbar palsies are bilateral because of bilateral innervation. Bulbar palsy causes tend to be disease related (muscle or nerve disorders) which would present bilaterally. In the presence of a unilateral bulbar palsy, I would strongly consider a space-occupying lesion/tumor.
Best regards,
LB
Useful to note the presence of flaccid dysarthria (speech) in people with bulbar palsy, which could include the hypernasal resonance and/or raspy vocal quality you described with weakness of the soft palate.
Thank you so much for simplifying it for us, it's very helpful
You're welcome!
Fantastic video for us med students. Looking forward to more of them.
Best video, I bless you hundred times for posting these kind of videos
This saved me from poring thru anatomy books 4 hours! Thank you!
You're welcome!
Achini Samaranayake You should still read the books. Come on!
excellent video. good usage of color to differentiate between BP and PBP. please do more of such videos.
You are very welcome! Please do continue to send your questions, jamshidbaheer :-)
Thank you so much for this presentation
Hi,
I do mention that gag reflex is absent (diminished) and I do note that that the jaw jerk is normal. I believe that your textbook is incorrect in stating that the jaw jerk is absent because of the explanation I give at 7:22: CN V anfd CN VII are exluded in bulbar palsy.
I hope this helps!
For further clarification, note that the lower motor neuron structures include the Cranial Nerve XII nuclei which function like the anterior horn cells in the cord. Both house the cell bodies of the peripheral nerves that ensue. The nerve itself is also a lower motor neuron structure, so damage in any of these structures can result in fasciculations.
(continued)
Fantastic! Clearly articulated and quality information.
Hi. Thanks for the video and resource. Quick question. When you say Cranial nerve XI do you mean CN IX?
CN XI, spinal accesory innervates the trapezius muscles and the sternocleidomastoid.
CN IX (Glossopharengeal) is involved with swallowing and gag reflex
Yes! Good catch!
mdambrosio3 yes because gag reflex is by ix CN and XI is responsible for drooping of shoulder so she mean IX here as gag reflex is getting affected
very nicely explained. thank you so much.
You're welcome! Thanks for the kind words.
❤@@NeuroDocUniverse
Hi Sarah,
The following is from: Brain (2001) Pathological laughter and crying: A link to the cerebellum. Vol 124, Iss 9, pp1708-1719: The traditional and currently accepted view is that PLC is due to the damage of pathways that arise in the motor areas of the cerebral cortex and descend to the brainstem to inhibit a putative centre for laughter and crying. In that view, the lesions `disinhibit' or `release' the laughter and crying centre...continued
I don’t know if I have Pseudobulbar but I probably don’t cause it triggers when I feel so stressed or when my mom barges in my privacy or when she tells me off and falsely accuses me. When she left the room, my head throbbed on one side and I bent down, randomly tears starting falling and I tried to wipe it off but it kept falling again and then I started laughing while crying. All I could think was how to leave, how to die, how to kill, how to end it all, how to be strong, how to be happy, etc.
This is fantastic! Thank you for such a clear explanation.
Excellent video very concise and clear
thanks
Glad it helped!
The critical PLC lesions occur in the cerebro-ponto-cerebellar pathways. THis is what allows the laughter without humorous context.
I hope this helps.
LKB
Best lecture on this topic. Thnks
One of the best. Looking forward to see more of your videos :)
Thank you very much for your efforts and time. It really helped.
Very helpful! Much appreciated!
Great video ! Very simple and helpful
Thanks for your great explanation. Can I ASK Which software are you using to create this black screen video.
Thank u 🙏
How is this related to one sided weakness of limb
The best explane. As for me. Thanks!
Excellent ehglish pronunciation.
thanks so much! this is really helpful.
excellent
The CN IX, glossopharyngeus nerve is missing here.
Thank u
Good video, however The corticospinal tract carries motor signals from the primary motor cortex in the brain, down the spinal cord, to the muscles of the trunk and limbs. ... The corticobulbar tract carries efferent, motor, information from the primary motor cortex to the muscles of the face, head and neck. They are not the same thing.
Agreed the pyramidal tracts are distinct pathways. Thanks for your note. The video could be improved by making that point clear.
Sorry to point the mistake, but if I am not wrong, Bulbar palsy is only motor palsy, GAG REFLEX will be normal i think. Can you recheck it. Thanks
fantastic
thank you
You're welcome!
Thank you❤️
You're welcome!
You're welcome!
Its so helpful ...thanks a lot dr
Thanx .
Hi, thanks for the video. A question
Please explain why water is necessary during and swallowing? Also how nasal speech occurs?
Hi! Water is not necessary in testing for bulbar palsy, but the patient may complain of fluid finding its way up the nasopharynx when swallowing. The nasal tone of the voice in a bilateral bulbar palsy is due paresis of the soft pallet due to cranial nerve X involvement. As a result, air during speech is allowed to escape through the nose. I hope this is helpful.
You are very welcome!
Nope. I use Camtasia (screen recording software). It's pretty good, though it's always wise to "save" frequently.
Hello dr thank you very much for this video i have a question why there is not an alteration of the upper half of the face despite the bilateral alteration of the supranucleus pathways
Thanks a ton mam. God bless u
very very helpful thank you
You're welcom!
Excellent
The upper motor neuron structures include anything from the motor cortex through the corticobulbar tract prior to synapsing on the nuclei. Damage along this pathway will result in spasticity of the tongue.
I hope this is helpful...
My text book says Bulbar palsy has absent jaw jerk and reduced or absent gag reflex. is this wrong?
Awesome! Thanks for the feedback!
Excellent video very concise and clear
thanks
@@agabaire Thanks for the feedback. Glad it was helpful!
Hi can you mention the references that you used to find this very helpful information :)
Amazing, thank you!
thank u!
You're welcome!
Excellent video. Really useful way of explaining these conditions! One question, i have written down in my notes that in End stage multiple sclerosis you will get pseudobulbar palsy (because of demyelination within CNS). However can patients present with pseudobulbar symptoms?
Demyelination of the connections between the primairy motor neuron (in the cortex) and the secundairy motor neuron (in the brain stem). White matter is also bart of the corticobulbair tract :)
very nice video
Great
THANK YOU SO MUCH!
many thanks
Why Bulbar Palsy only CN X, XI and XII? CN V and VII also have nuclei on bulbar too tho
Yes, cranial nerve V and VII nuclei are in the brainstem, but are involved in pseudobulbar palsy and not bulbar palsey. Let me know if you need further explanation or if I did not understand your question.
YOU ARE THE BEST
Thank
you!!!
excellent thank You a lot!!!!!!!!!!!!!!!
Thank you so much for this great video! But just a quick question... are the same results seen in the SCM and traps as well i.e. spasticity and fasciculations and atrophy or not due to collateral innervation? thank you again! :D
You're welcome!
great video,. thanks. what software did u use to write ? and record ?
Thanks! Camtasia and a Wacom tablet.
thank you, i do have wacom tablet but did u use the software which came with it to write or is it some other software?.
Why does is CN5 and CN7 have to be from Upper motor neuron lesion and not Lower motor neuron?
BP is about the nerves that emerge of the medulla
Hi!
Can you clarifiy your question? I'm not sure what you're asking...
Thanks!
NDU
thanks, its helpful!
thanks a lots 😍😍
i am not medically trained. My memory fades and i am emmotionally Highly strung. My neuro fails to make a final diagnoses even though they ar "the best" in the area. My situation is apperantly UNIQUE???
chalk6666
Hi! How are you with your problem now? May I have wide answer from you?
Mam... Won't the Jaw Jerk be absent in Bulbar Palsy? or is it normal as you mention in the video. Kindly explain.
pretty much the same thing. in normal people jaw jerk is absent and it's normal. but some people can have slightly present jaw jerk and it still can be normal.
Drooling of saliva occurs in both bulbar and pseudo bulbar palsy ?
I wish neural disorders were as clear cut as neurologists make them seem didactically!
Hello, my name is David. I have been diagnosed with MND Vs MultiFocal motor Nueropathy,I am being treated with IGIV Immunoglobulin, I believe i have MND as I am no responding to the treatment. Symptoms..Fasiculations Face, limbs body and tongue. My Gag reflex was initially over reactive and has dimminished to under active. Forgive my terminoligy,
chalk6666
Hi! How are you with your problem now? May I have wide answer from you?
Bulbar palsy affects IX X and XII not X XI XII.
My mother has been diagnosed with PBP and she exhibits excessive crying and emotional distress that she cannot articulate as to why she is crying. Is this another symptom?
Yes as well as laughter
does pseadobulbar cause laughter? cause i have like pathological laughter?
Yes
hlo. can respiratory impairment happen in bulbar palsy ??? plzz answer me
paralysis of both vocal folds.
THANKKK YOUUUU SO MUCHHH :D
You didn't tell about nine cranial nerve
video is nice but plz correct the 9th n. involvement rather than saying it to be 11th n.
In both bulbar and pseudobulbar, her 11th actually mean 9th ?
Well when are you people going to actually cure patients instead of just billing the hell out of them and keeping them sick?