Re: palatal weakness

Posted By CCF Neuro MD MJD on October 14, 1998 at 10:40:37:

In Reply to: palatal weakness posted by Jenny on October 13, 1998 at 21:03:06:






Is there any other cause for unilateral palatal weakness (palate does not
elevate on left side) other than bulbar ALS (such as hyperthyroid problem)?
I do not have noticeable difficulty swollowing, but I do have fasciculations
and muscle weakness in shoulders and hips which has been going on for about
2 months.  Please explain also how bulbar ALS presents.







The palate can be affected unilaterally by anything affecting the nerves supplying the palate from their origin in the brainstem to the point where they meet the muscle  (the causes of bilateral palatal weakness are many; to what extent the palate is involved clinically can be difficult).  So anywhere along this pathway, a lesion (for example,stroke in the brainstem, tumor)might cause unilateral palatal weakness. This should be investigated with imaging of these regions.  Of course, the fasciculations and arm/leg weakness you describe would not be easily explained by many of these causes if one is to find a unifying diagnosis for all your problems.  Muscular diseases and Neuromuscular junction diseases (where the end of the nerve meets the muscle) can cause palatal weakness (though usually bilateral) and muscular weakness but not typically fasciculations (are these fasciculations? there are many types of muscle twitchings).  Also, as you pointed out motor neuron diseases (for example, ALS) may cause problems like this too.  The important thing now is the evaluation by a good neurologist to try and clarify the location of your problem - this starts with a good history and physical.  After this, you may need an Electromyogram (EMG), an electrical study of the nerves and muscles, to help better clarify the distribution of nerve involvement and whether these muscle movements are fasciculations.  Involvement of Speech Therapy for a swallowing evaluation, if not performed already, will also be necessary.  Hope this is of help.