Isolated Accessory Nerve Palsy of Spontaneous Origin

Abstract
Four cases of unilateral accessory nerve palsy occurring without any definitive cause are described. The condition is severe in onset with neck pain, and subsequent atrophy and weakness of the trapezius and to a variable degree the sternomastoid. The associated winging of the scapula may be confused with that accompanying serratus anterior palsy; and the clinical differences between the two types of winging are stressed. Added difficulty may arise when trapezius and serratus anterior palsy coexist, as occurred in one case. Electromyography demonstrated slowing of the accessory nerve conduction and evidence of denervation of the trapezius and sternomastoid muscles. The accessory nerve palsy is compared with other types of spontaneous, acute onset, restricted neuropathies.

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