Bulbar involvement

In padents with bulbar involvement, symptoms of hoarseness, slurred speech, and drooling most often precede evidence... 

The use of peak cough flow (PCF) and peak expiratory flow (PEF) are also useful in monitoring expiratory muscle weakness and bulbar involvement (32,33). When PCF is... 

Acute paralytic poliomyelitis is still endemic in some countries and vaccine-associated poliomyelitis continues to occur (125). After many years of stability, some patients do deteriorate (126). This post-polio syndrome may be characterized by the development of progressive weakness associated with respiratory symptoms among those ventilated during their acute illness (127). Respiratory failure results from thoracic restriction as well as muscle weakness and bulbar involvement (128). Tracheostomy can be avoided with continuous NIV and aggressive mechanical in-exsufflation (128). Retrospective studies of NIV have reported survival rates >90% at five years, making this group the one with the highest benefit (76,129). 

Farrero E, Prats E, Povedano M, et al. Survival in amyotrophic lateral sclerosis with home mechanical ventilation the impact of systematic respiratory assessment and bulbar involvement. 

Androgens act via the AR and play an important role in the development and differentiation of the male sexual organ. Furthermore, they are involved in several diseases, the most important being partial and complete androgen insensitivity syndrome (AIS formerly known as the testicular feminization syndrome), spinal and bulbar muscle atrophy (SBMA Kennedy s disease), and the neoplastic transformation of the prostate. The two natural occurring androgens are testosterone (T) and the... 

In severe cases, or those refractory to treatment, truncal and limb weakness may be accompanied by involvement of masticatory, bulbar, and respiratory muscles. However the most life-threatening clinical manifestations are those affecting the gastrointestinal tract, since stomach ulceration can occur and death from perforation and peritonitis are not unknown. Medication with steroidal antiinflammatory agents is necessary but weakens the childrens resistance to infection, so that systemic spread of usually self-limiting disorders, such as candidiasis, may occasionally occur. 

In addition to the corneal route, topically applied ocular drugs may be absorbed via a noncorneal absorption route that involves drug transport across the bulbar conjunctiva and underlying sclera into the uveal tract and vitreous humor.65 The intercellular spaces of the conjunctival epithelium are wider than those of the corneal epithelium. As a result, the conjunctiva has higher permeability than the cornea to agents such as mannitol, inulin, and FITC-dextran.86 The penetration of peptides, however, is limited by enzymatic degradation.87 The limit of molecular size for conjunctival penetration is between 20,000 and 40,000 Da. Vitreous can act as an aqueous and unstirred diffusion barrier to drug permeation.64... 

Morphine depresses all phases of respiration (respiratory rate, tidal volume, and minute volume) when given in subhypnotic and subanalgesic doses (Figure 47.6). In humans, a morphine overdose causes respiratory arrest and death. Therefore, morphine and other narcotic analgesics should be used with extreme caution in patients with asthma, emphysema, and cor pulmonale, and in disorders that may involve hypoxia, such as chest wound, pneumothorax, or bulbar poliomyelitis. 

In its early stages trachoma presents as a chronic follicular conjunctivitis with a predilection for the superior tarsal and bulbar conjunctiva. Over time, the conjunctival reaction becomes papillary in nature and, with the inflammatory infiltration that occurs, the follicular character of the infection can become obscured. Patients experience symptoms of photophobia, tearing, and mucoid or mucopurulent discharge. Limbal edema and superior bulbar conjunctival hyperemia also may occur. Conjunctival follicles that form at the limbus are characteristic of severe trachoma. Primary corneal involvement often includes superior epithelial keratitis and superficial superior pannus formation. A wide variety of corneal infiltrates... 

The neuromuscular dysfunction is a very interesting phenomenon in this enigmatic condition. This condition presents with a classical triad of marked hypokalemia, TTX and severe quadraparesis. Quadraparesis may involve any muscle group, including the bulbar muscles and infrequently the cranial nerves, but the lower limbs are the most affected. Although the condition is often not life-threatening,... 

Musculoskeletal disorders (NMD and TRD) are relatively uncommon, but when present are often complicated by respiratory failure (20). Data on the burden of patients with CRF from musculoskeletal disorders are quite heterogeneous. Of the 79 patients who received HMV for CRF in a rehabilitation facility in California, 64% had poliomyelitis with bulbar and respiratory involvement (21), the next most common being Duchenne s muscular dystrophy. Other studies have reported CRF in scoliosis, kyphosis, and post-thoracoplasty TRD, as well as in myopathies such as Ducheime s muscular dystrophy, myotonic dystrophy, postpoliomyelitis, and amyotrophic lateral sclerosis (22). 

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