The lesion is located in both the upper motor neurons in the brain stem or above. Clinically, patients are emotionally unstable, signs of upper motor neurone lesion are present on both sides. Dysphagia and dysarthria (spastic speech) may also be seen.Tongue on protrusion is seen to be small and spastic but wasting is absent. Jaw jerk is found to be brisk and is an important sign. Gag reflex is depressed.
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