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Accessory Nerve Palsy
Eleventh Cranial Nerve Disorder

Presentation

We describe the previously unreported occurrence of a glomus tumour presenting with a unilateral accessory nerve palsy. [ncbi.nlm.nih.gov]

Neurologic

  • Cranial Nerve Involvement

    Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are the most rare. [ispub.com]

Workup

[…] muscle—greater auricular nerve (GAN) flap, with the advantage of having an interpositioned graft vascularized by fascia and muscle with no donor site morbidity. [10] Diagnostic methods and nerve-salvaging strategies are discussed in further detail in the Workup [emedicine.medscape.com]

If new symptoms or significant worsening of existing symptoms occurs, neuroimaging, electrodiagnostics, or surgical referral should be considered. 8 Patients who have multiple occurrences of stingers should also have a more thorough workup, because they [aafp.org]

Treatment

Accessory Nerve Injury Treatment and Management. Medscape. 2016. Found at: http://emedicine.medscape.com/article/1298684-treatment#d9 [oncolink.org]

A surgical reconstruction was proposed as the most efficient treatment, but our patient declined this. [scienceopen.com]

Treatment The treatment of spinal accessory nerve palsy includes physical therapy as the main conservative or non-surgical component. For patients not responding to the conservative methods, surgery is considered for them. [mistysurimd.com]

This case report suggests that isolated spinal accessory nerve palsy should be considered in cases of shoulder pain or weakness after CABG, and conservative treatment is recommended if palsy develops. [ncbi.nlm.nih.gov]

Prognosis

The prognosis was better following blunt trauma, stretch injuries and after a spontaneous onset. The anatomical relationships of the accessory nerve and aspects of the clinical picture and management are discussed. [ncbi.nlm.nih.gov]

EMG testing can help guide prognosis, direct conservative and surgical treatment, and reduce patient morbidity. [content.iospress.com]

[…] partial forms that are well-tolerated. [1] Although MRI reveals muscle abnormalities in more than 50% of cases, the most helpful diagnostic tests in confirming SAN palsy are nerve conduction studies and electromyography. [3] The role of EMG in predicting prognosis [neurologyindia.com]

Etiology

Various rare etiological factors were also described. Whatever the etiology, the typical clinical features of SAN palsy can be listed as atrophy/weakness of the trapezius muscle and moderate winging of the scapula. [ncbi.nlm.nih.gov]

Etiology Clinical features Extorsion of the eye : inability to depress and adduct the eyeball simultaneously (the pupil shoots upward during attempted adduction of the eyeball) Diplopia ( double vision ) Mild esotropia Trigeminal nerve lesion (V) Etiology [amboss.com]

The most common etiology is iatrogenic injury following surgical procedures at the posterior triangle of the neck. We present three cases of isolated injury to the SAN following trauma. [content.iospress.com]

Epidemiology

[…] shoulder and upper arm level, left arm, initial encounter A- initial encounter D- subsequent encounter S- sequela Scapular Winging ICD-9 907.4 (Late effect of injury to peripheral nerve of shoulder girdle and upper limb) Scapular Winging Etiology / Epidemiology [eorif.com]

Compression Fracture callus Coracobrachialis muscle 5 Backpack palsy Stretch injury Multifocal motor neuropathy Upper/lower subscapular nerves Authors are not aware of any reported cases of mononeuropathy Evaluate for spinal nerve/brachial plexus lesion Epidemiology [now.aapmr.org]

Epidemiology Frequency Iatrogenic SAN injury most commonly occurs following diagnostic lymph node biopsies of the posterior triangle of the neck. Injury rates from these procedures are reportedly 3-8%. [emedicine.medscape.com]

Pathophysiology

Includes separate chapters focusing on individual neurologic disorders with detailed descriptions from pathophysiology to in-depth analysis. [books.google.com]

[…] neuritis Syringomyelia A study by Kassem et al suggested that idiopathic brachial plexitis can affect the spinal accessory nerve and may be sparked by surgical procedures. [21] Miscellaneous Spontaneous isolated nerve injury has also been reported. [22] Pathophysiology [emedicine.medscape.com]

[…] deltoid Sensory: C5 and C6 dermatomes No protective coverings (epineurium and perineurium) on the nerves after they exit the foramina Increased risk of stretch injury at neck and shoulder regions Contusion or compression of upper trunk at Erb point Pathophysiology [aafp.org]

Prevention

Builds a knowledge base of required skills for the necessary close observation and monitoring of the neuroscience patient to prevent complications and achieve the best outcomes. [books.google.com]

Patient & family education Counsel patient/family regarding expected course of improvement depending on type of lesion (eg neurapraxic vs axonal) and importance of physical therapy to prevent contracture and improve function. [now.aapmr.org]

Physicians at the East-Carolina Brody School of Medicine are currently analyzing these cases in cooperation with the regional Center for Disease Control and Prevention. Hopefully the results will be available soon. [practicalneurology.com]

Bilateral weakness may prevent the patient from lifting their head off a pillow and the head may be inclined posteriorly for lack of flexor tone. Bilateral weakness suggests muscle or neuromuscular disease. [dartmouth.edu]

The neurotoxin consists of molecules that bind to nerve endings and prevent the release of stimulating neurotransmitters. This means the nerve signal is blocked from reaching the muscle, and hence the muscles no longer contract. [umanitoba.ca]

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