Alexanders (type 2), which primarily has an adult onset with the presence of muscle weakness, hyperreflexia, bulbar or pseudobulbar symptoms, signal abnormalities and atrophy observed in an MRI of the medulla oblongata and upper cervical spinal cord
The fatal sequelae of this type of bite are bulbospinal
paralysis, including respiratory paralysis.
Another potential contribution to the pain-generating mechanism is the role of descending bulbospinal
The symptoms of detrusor hyperreflexia, such as frequency, urge incontinence, and incomplete emptying, are caused by spinal cord plaques disrupting the bulbospinal
pathways from the pontine micturition center (Dierich, 2000; Goodwin & Fowler, 1997; MSCCPG, 1999; Schapiro, 1998).