Speech Difficulty, Swallowing Issue, Less Tongue Movement, Tests Normal. Bulbar Palsy?

Posted on Tue, 11 Sep 2012

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 11 Sep 2012 Answered on

Thu, 4 Oct 2012 Last reviewed on

Question : I have had some speech difficulties for about 8 months, slurring/lisp. SOem slight swallowing issues too but nothing severe or often. I have had a brain MRI, neck CT, blood work for MG, MS, tumor, etc. All negative. My tongue has less movement than it did, I do bite the left side of my tongue nearly every night. My tongue feels like it has current running through the surface and the tip is sensitive. If I stick it out it does undulate or pulsate, but inside at rest it does not. I have had stomach acid problems too and currently take 2 previcid per day. Does any of this sound like Bulpar Palsy, or am I reading too many posts online.
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Answered by Dr. Sudhir Kumar (-4 hours later)

Dear Mr XXXXXXX
Thank you for posting your query on Healthcare Magic.
I have gone through your symptoms. The symptoms of speech and swallowing problems do occur in bulbar palsy (a type of evidence at the moment to label you as a case of bulbar palsy.
In bulbar palsy, speech problems can be of two types- one with a nasal twang in voice and the other a strained & effortful voice. Swallowing problems can also be of two types- one with a nasal regurgitation of liquids and the other with cough while swallowing.
In addition, people with bulbar palsy often have weakness and wasting (thinning of muscles) of hand and leg muscles.
It is good to note that your MRI brain is normal and also work up for myasthenia gravis is negative.
Other possibility could be dystonia or laryngeal and pharyngeal muscles.
So, I do not think that you have bulbar palsy at present, but it is better you cosult the neurologist and get a NCV/EMG studies performed.
Please get back if you have any further queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (40 hours later)

I do have slight regurgitation through my sinuses but rarely, if ever does anything actually come out my nose. Even more rare is actual choking on food, it has happened but both types of issues have been happening to me for more than 3 years. Both of these rare occurrences became even more rare since I started 2x daily Previcid last year. I had a swallowing study/xray done in July and was told I passed with only one instance of swallowing hesitation. I also seem to have a more nasally type voice than before although it could be described as a lisp. The speech issue started sometime last fall or winter.
My next test is a tongue, and maybe limbs too, EMG. I guess that will be the big determining factor.
Thank you
Joel C XXXXXXX

Answered by Dr. Sudhir Kumar (3 hours later)

Dear Mr XXXXXXX
Thank you for getting back regarding your symptoms in more detail. As you have mentioned, the speech and swallowing symptoms are not significant.
As you said, EMG studies should be performed in due course of time, if your symptoms persist or worsen.
Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar