This occurs in 3-5% of all patients, but is more prevalent in familial cases. Pseudobulbar palsy
Features are due to degeneration of corticobulbar pathways to V, VII, X, XI and XII cranial nerve motor nuclei (with sparing of III, IV and VI).
There is an apparent weakness of the muscles of mastication and expression, the patient has difficulty in chewing and the face is expressionless. The jaw jerk (page 15) is exaggerated.
Food and fluid enter nasopharynx when swallowing -palatal weakness (X).
Gag reflex is brisk when soft palate is stimulated. Speech is drawling and monotonous. Swallowing for solids is difficult (X). Tongue is immobile, pointed and cannot protrude (XII). Emotional lability - unprovoked outbursts of laughing or crying occur.
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