Spastic dysarthria (Pseudobulbar palsy)

Lesion

UMN lesions-cerebral cortex, internal capsule, midbrain

Clinical signs

Spastic paralysis (Totally X move) /paresis (weak)

Little or no muscle atrophy

Hyperactive muscle reflexes

Pathological reflexes (positive Babinsky)-touch sole of foot for response

Direct Activation Pathways=pyramidal tracts

Cortico spinal tract- motor control of limbs

Cortico mesencephalic tract- motor supply extrinsic muscles of eye

Cortico bulbar tract: MOST IMPORTANT part of DAP for speech, terminate in LMN nuclei of all relevant cranial nerves: IMPT to consider, majority of fibres cross to contralateral side, some ipsilateral fibres

Cortico-bulbar lesion

Unilateral

Bilateral

Spastic weakness, contralateral lower half of face

Upper part STILL receives __

Spastic weakness of both upper, lower face on both sides

Severe dysarthria

Persistent dyarthria is caused by

Bilateral disruption of UMN to bulbar cranial nerves

Spastic paralysis affecting bulbar musculature

Characterised by

Bilateral facial paralysis

Dysphagia, drooling

Bilateral hemiparesis- weakness of upper limbs

Incontinence

Emotional lability bcos of frontal lobe damage- eg uncontrollable laughter, crying

Hypophonia

Hyperactive jaw, sucking reflexes-DONT PUT FINGERS IN THEIR MOUTH