Acute pseudobulbar or suprabulbar palsy
G. Besson, J. Bogousslavsky, F. Regli and P. Maeder
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
We studied 13 patients with supranuclear lower cranial nerve
("pseudobulbar" or "suprabulbar") palsy of acute onset. While seven
patients had had a prior stroke, six patients had no history of stroke.
Eight patients experienced a complete bilateral supranuclear lower cranial
nerve palsy, which was isolated in five patients and associated with
hemiplegia and with hemiparesis in three patients. Pseudobulbar palsy was
partial in five patients. Only one patient had neuropsychologic impairment.
The pseudobulbar features improved or recovered within a few weeks in all
patients. The common characteristic of the lesions on computed tomography
or magnetic resonance imaging was the interruption of the corticonuclear
pathways contrasting with marked sparing of the corticospinal pathways in
both hemispheres. These lesions were either an opercular infarct, or a deep
infarct in the corona radiata or internal capsule, or a lenticular
hemorrhage. Hypertension was the most prevalent concomitant. Our findings
suggest that acute pseudobulbar or suprabulbar palsy has rather stereotyped
anatomic-vascular correlates and time course.
