Browse the corpus

©2013 UpToDate ® Print Email Bulbar signs and symptoms associated with amyotrophic lateral sclerosis Upper motor neuron signs Increased jaw reflex Jaw spasticity Facial diparesis (may be asymmetric) Increased facial reflexes Palmomental sign Poor palatal elevation Slow tongue movement Lower motor neuron signs Weak masseter and or pterygoids Difficulty maintaining jaw closure Facial diparesis (may be asymmetric) Poor palatal elevation Tongue weakness Muscle atrophy and fasciculations Upper motor neuron symptoms Jaw stiffness with difficulty opening the mouth Spontaneous clenching or biting Trismus Spontaneous jaw clonus Dysphagia Tongue incoordination disrupts the oral phase Pharyngeal muscle incoordination disrupts the pharyngeal phase Dysarthria Labial, lingual and/or pharyngeal components Spastic with slow, strained speech Laryngospasm Often triggered by secretions (eg, saliva) or food particles Rapid onset "Squeezing" feeling, inability to speak, strained speech Short-lived, less than 30 seconds Pseudobulbar affect Inappropriate laughing, crying, and/or yawning Affective response >> emotional trigger Mood incongruent Sialorrhea (drooling) Difficulty managing pharyngeal secretions Lower motor neuron symptoms Incomplete eye closure Difficulty opening and/or closing the jaw Difficulty chewing Disarticulation of the temporomandibular joint when severe Poor lip closure and seal May contribute to sialorrhea when severe Dysphagia Tongue weakness disrupts the oral phase Pharyngeal muscle weakness disrupts the pharyngeal phase Coughing and choking induced by drinking, eating or saliva secretion Often thin liquids followed by solids and thick liquids Dysarthria Labial, lingual and/or pharyngeal components Slurred, nasal and/or hoarse speech Hoarseness