generate barcode in c#.net DISEASES OF THE CRANIAL NERVES in Microsoft Office

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The Eleventh, or Spinal Accessory, Nerve
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Anatomic Considerations This is a purely motor nerve, of spinal rather than cranial origin Its bers arise from the anterior horn cells of the upper four or ve cervical segments and enter the skull through the foramen magnum Intracranially, the accessory nerve travels for a short distance with the part of the tenth nerve that is derived from the caudalmost cells of the nucleus ambiguus; together, the two roots are referred to as the vagal-accessory nerve or cranial root of the accessory nerve The two roots leave the skull through the jugular foramen The aberrant vagus bers then rejoin the main trunk of the vagus, and the bers derived from the cervical segments of the spinal cord form an external ramus and innervate the ipsilateral sternocleidomastoid and trapezius muscles Only the somatic motor bers constitute the accessory nerve in the strict sense In patients with torticollis, however, division of the upper cervical motor roots or the spinal accessory nerve has often failed to ablate completely the contraction of the sternocleidomastoid muscle This suggests a wider innervation of the muscle, perhaps by bers of apparent vagal origin that join the accessory nerve for passage through the jugular foramen A complete lesion of the accessory nerve results in weakness of the sternocleidomastoid muscle and upper part of the trapezius (the lower part of the trapezius is innervated by the third and fourth cervical roots through the cervical plexus) Weakness can be demonstrated by asking the patient to shrug his shoulders; the affected side will be found to be weaker, and there will often be evident atrophy of the upper part of the trapezius With the arms at the sides, the shoulder on the affected side droops and the scapula is slightly winged; the latter defect is accentuated with lateral movement of the arm (with serratus anterior weakness, winging of the scapula is more prominent and occurs on forward elevation of the arm) When the patient turns his head forcibly against the examiner s hand, preferably starting with the head deviated to the opposite side, the sternocleidomastoid of the opposite side does not contract rmly beneath the ngers This muscle can be further tested by having the patient press his head forward against resistance or lift his head from the pillow Motor system disease, poliomyelitis, syringomyelia, and spinal cord tumors may involve the cells of origin of the spinal accessory nerve In its intracranial portion, the nerve is usually affected along with the ninth and tenth cranial nerves by herpes zoster or by lesions of the jugular foramen (glomus tumors, neuro bromas, metastatic carcinoma, jugular vein thrombosis) Tumors at the foramen magnum may also damage the nerve In the posterior triangle of the neck, the eleventh nerve can be damaged during surgical operations and by external compression or injury Compressive-invasive lesions of this nerve may be visualized by computed tomography or MRI of the posterior cervical space A benign disorder of the eleventh nerve, akin to Bell s palsy, has been described by Spillane and by Eisen and Bertrand It begins with pain in the low lateral neck that subsides in a few days and is followed by weakness and atrophy in the distribution of the nerve Also, a recurrent form of spontaneous accessory neuropathy has been described (Chalk and Isaacs) About one quarter to one third of eleventh nerve lesions are estimated to be of this idiopathic type; most but not all of the patients recover Bilateral sternocleidomastoid and trapezius palsy, which occurs with primary disease of muscles eg, polymyositis and muscular dystrophy may be dif cult to distinguish from a bilateral affection
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of the accessory nerves or the motor nuclei (progressive bulbar palsy) The supranuclear innervation of the spinal accessory nuclei is apparently mainly ipsilateral as evidenced by contraversive turning of the head during a seizure, the result of contraction of the ipsilateral sternocleidomastoid muscle Whether this is attributable to a direct ipsilateral tract, or to double crossing, is not known
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