Annals of Indian Academy of Neurology
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This prospective observational study of 54 patients found that posterior circulation stroke (PCS) was the most common cause of acute bulbar weakness (68.5%), followed by Guillain-Barre syndrome (11.1%). Mortality was high (48%), with PCS accounting for the majority of deaths (33.3%), highlighting the need for early intervention to reduce mortality and morbidity.
**Background:** Bulbar palsy, a lower motor neuron palsy affecting cranial nerves IX, X, XI, and XII, can result from various conditions including posterior circulation stroke (PCS), motor neuron disease (MND), Guillain-Barre syndrome (GBS), myasthenia gravis, infectious neuropathies, and toxic causes like snake bite. This study aimed to analyze the spectrum of disorders presenting with acute onset bulbar weakness, their etiology, clinical profile, need for emergency management, and patient outcomes in a tertiary care hospital.
**Methods:** This was a prospective observational study conducted at Government Mohan Kumaramangalam Medical College, Salem, Tamil Nadu, India, over a duration of 1 year. Patients admitted with acute bulbar weakness who fulfilled inclusion and exclusion criteria were enrolled. Data on clinical presentation, etiology, and outcomes were collected and analyzed.
**Key Results:** A total of 54 patients with acute bulbar weakness were included. The most common etiology was posterior circulation stroke (PCS), found in 37 patients (68.5%). Other causes included Guillain-Barre syndrome (GBS) in 6 patients (11.1%), motor neuron disease (MND) in 3 patients (5.5%), and 2 patients each (3.7%) with hypokalemic paralysis, rabies, and diabetic cranial neuropathy. One patient each (1.8%) had snakebite and myasthenia gravis. The most common age group affected was 60-70 years (42%). Males were more frequently affected (38 patients, 70%) than females (16 patients, 30%). Overall mortality was 48% (26 patients died), while 28 patients (52%) survived. The most common cause of death was posterior circulation stroke, accounting for 18 deaths (33.3% of total patients).
**Clinical Implications:** This study demonstrates a varied clinical profile in patients presenting with acute bulbar weakness, with posterior circulation stroke being the most common cause and associated with a high mortality rate. Early recognition and intervention are crucial to potentially reduce mortality and morbidity in these patients. The findings underscore the importance of prompt evaluation and management of acute bulbar weakness, particularly to identify and treat PCS.