Facial disturbance

Question 1

Bulbar palsy (3)

Answer 1

• Flaccid fasiculating tongue
• Jaw jerk normal/absent
• Quiet/hoarse/nasal speech

Question 2

Psuedo (cortico)bulbar palsy (6)

Answer 2

• Slow tongue movements
• Slow deliberate speech
• Increased jaw jerk
• Increase pharyngeal/palatal reflexes
• Increased pharyngeal + palatal reflexes
• Puesdobulbar affect (PBA) = weeping/giggling without mood match

Question 3

What distinguishes MND from MG?

Answer 3

No involvement of eye movements

Question 4

What is the typical age of MND?

Answer 4

40+

Question 5

MND typical face sign + additional symptoms (4)

Answer 5

- Tongue fasiculations + weakness
Additional:
- Stumbling spastic gait
- Foot drop
- Proximal myopathy

Question 6

Occular myasthenia gravis (4)

Answer 6

• Bilateral asymmetric ptosis
• Ptosis worsens with sustained upwards gaze
• Diplopia
• “Peek sign” : eyelids seperate after sustained closure

Question 7

Occular MG vs puesdobulbar/bulbar palsy?

Answer 7

2nd involves bulbar function i.e speech/tongue/mouth/jaw jerk