Spinal accessory neuropathy (SAN) is commonly caused by an iatrogenic procedure, and that caused by tumors is very rare. We present a case of a 49-year-old man suffering from weakness in the right trapezius and sternocleidomastoid muscle. An electrophysiology study confirmed proximal SAN. Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) revealed a diffuse large B-cell lymphoma compressing the right spinal accessory nerve. Ultrasonography showed definite atrophy on the trapezius and sternocleidomastoid muscles. In addition, post-chemotherapy FDG-PET/CT showed increased FDG uptake in the right upper trapezius, suggestive of denervation. This is the first report of SAN caused by direct compression by a diffuse large B-cell lymphoma, comprehensively assessed by an electrophysiology study, ultrasonography, and FDG-PET/CT.
Accessory Nerve ; Atrophy ; B-Lymphocytes ; Denervation ; Electrophysiology ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Middle Aged ; Muscles ; Superficial Back Muscles ; Ultrasonography

Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.
Accessory Nerve Injuries* ; Accessory Nerve* ; Adult ; Ambulatory Care Facilities ; Electromyography ; Female ; Follow-Up Studies ; Humans ; Musculoskeletal Manipulations* ; Needles ; Neural Conduction ; Range of Motion, Articular ; Shoulder ; Shoulder Pain

Anatomical variations of the sternocleidomastoid muscle (SCM) have been observed to occupy multiple origins and insertion points and have supernumerary heads, sometimes varying in thickness. During routine dissection, a SCM was observed to have six distinct insertions that interface with the course of the superior nuchal line, ending at the midline, bilaterally. This variation was also seen to receive innervation from the accessory nerve as well as the great auricular nerve. To our knowledge, this variant of supernumerary insertions and nerve innervations has not yet been reported. These variants may pose as problematic during surgical approaches to the upper neck and occiput, and should thus be appreciated by the clinician. Herein we discuss the case report, possible embryological origins, and the clinical significance of the observed variant SCM.
Accessory Nerve ; Head ; Mastoid ; Neck

The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.
Accessory Nerve ; Brachial Plexus ; Cervical Plexus ; Cervical Vertebrae ; Cranial Nerves ; Female ; Ganglia, Sympathetic ; Humans ; Magnetic Resonance Imaging ; Neck* ; Pathology* ; Signal-To-Noise Ratio ; Vagus Nerve

Accessory Nerve ; transplantation ; Birth Injuries ; complications ; surgery ; Brachial Plexus Neuropathies ; etiology ; surgery ; Child, Preschool ; Early Medical Intervention ; Elbow ; Humans ; Infant ; Intercostal Nerves ; transplantation ; Nerve Transfer ; methods ; Radial Nerve ; surgery ; Sural Nerve ; transplantation ; Time Factors ; Treatment Outcome ; Ulnar Nerve ; transplantation

Ultrasound of cranial nerves is a novel subdomain of neuromuscular ultrasound (NMUS) which may provide additional value in the assessment of cranial nerves in different neuromuscular disorders. Whilst NMUS of peripheral nerves has been studied, NMUS of cranial nerves is considered in its initial stage of research, thus, there is a need to summarize the research results achieved to date. Detailed scanning protocols, which assist in mastery of the techniques, are briefly mentioned in the few reference textbooks available in the field. This review article focuses on ultrasound scanning techniques of the 4 accessible cranial nerves: optic, facial, vagus and spinal accessory nerves. The relevant literatures and potential future applications are discussed.
Accessory Nerve ; Cranial Nerves* ; Peripheral Nerves ; Ultrasonography*

We report a case of multiple cervical schwannomas mimicking cervical nodal metastasis in a 45-year-old female patient with papillary thyroid carcinoma. Ultrasonography revealed a hypoechoic lesion with irregular contour in the left isthmus of the thyroid gland. A contrast-enhanced CT of the neck showed two well-circumscribed, cystic masses in the left cervical level II. The preoperative results of ultrasonography guided fine needle aspiration biopsy from both thyroid and lateral neck masses were papillary thyroid cancer and atypical cell, respectively. Considering clinical and imaging results, the lateral neck masses were suspected to be metastatic cervical lymphadenopathy. During surgery, however, we identified that two lateral neck masses were originated from spinal accessory nerve and cervical plexus. The pathologic examination confirmed that lateral neck masses were typical schwannomas. Before surgery, it is important to make every efforts to discriminate metastatic lymphadenopathy from the cystic neck mass in patients with papillary carcinoma.
Accessory Nerve ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Cervical Plexus ; Female ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Middle Aged ; Neck ; Neoplasm Metastasis ; Neurilemmoma* ; Thyroid Gland ; Thyroid Neoplasms* ; Tomography, X-Ray Computed ; Ultrasonography

Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.
Accessory Nerve* ; Cerebellar Ataxia ; Electromyography ; Female ; Hoarseness ; Humans ; Hypesthesia ; Intracranial Hypertension ; Middle Aged ; Needles ; Neurilemmoma* ; Spinal Cord Diseases ; Spinal Nerve Roots

The brachiocephalic muscle in domestic mammals is formed as a homology of the sternocleidomastoid muscle and the clavicular part of the deltoid muscle since it results from reduction of the clavicle as a clavicular intersection. The cranial insertions of the brachiocephalic muscle vary among species in domestic mammals. In the dog, the brachiocephalic muscle comprises three parts, which arise from the clavicular intersection and insert at the humerus, the dorsal cervical raphe, and the mastoid process of the temporal bone. These three parts are named the cleidobrachial muscle, the cervical part of the cleidocephalic muscle, and the mastoid part of the cleidocephalic muscle, respectively. This complexity could confuse veterinarians and complicate surgical procedures in this area. Information about the normal structure of this muscle, and any variation therein, would help to avoid such situations. During dissections of a male cross-breed dog, we found that the brachiocephalic muscle had two bellies located on the mastoid part of the cleidocephalic muscle that extended from the clavicular intersection to the wing of the atlas and the mastoid process of the temporal bone. They were innervated by the accessory nerve and the ventral branches of the second, third, and fifth cervical nerves, and they were supplied by the ascending branch of the superficial cervical artery. These bellies were considered to be a rare variation of the muscle. This is the second report of a brachiocephalic muscle variation in a dog, in which the mastoid part of the cleidocephalic muscle was made of two bellies inserted independently. Such variations should be considered during anatomical dissections and surgical procedures.
Accessory Nerve ; Animals ; Arteries ; Clavicle ; Deltoid Muscle ; Dogs* ; Humans ; Humerus ; Male ; Mammals ; Mastoid ; Temporal Bone ; Veterinarians

We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.
Accessory Nerve ; Atlanto-Occipital Joint ; Atrophy ; Cranial Nerve Injuries ; Cranial Nerves ; Deglutition ; Deglutition Disorders ; Dislocations ; Electromyography ; Humans ; Larynx ; Magnetic Resonance Imaging ; Muscles ; Neck ; Palate, Soft ; Pharynx ; Physical Examination ; Pyriform Sinus ; Survivors ; Tongue