| 제목 |
Isolated unilateral cranial XI nerve palsy after traumatic brain injury : a case report |
| 소속 |
Kyung Hee University Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Jae Joon Lee1*, Yunsoo Soh1†, Hee-Sang Kim1, Jong Ha Lee1, Dong Hwan Yun1, Jinmann Chon1, Yong Kim1, Myung Chul Yoo1 |
There have been several reports of various traumatic lower cranial nerve injury that usually followed a fracture through the jugular foramen or occipital condyle fracture (OCF). Thus, the anatomical location can account for the frequent occurrence of lower cranial nerve deficits following these fractures but only a few cases are reported and isolated single nerve palsy is extremely rare. We report a case of skull base fracture near pars vascularis of right jugular foramen, which was clinically associated with isolated cranial nerve XI palsy with shoulder weakness as the chief complaint
A 60-year-old male was sent to the emergency department after falling from 3m height during roof repair. He had no particular history of underlying deseases. He slowly recovered his consciousness after two months of inpatient treatment. According to the patient, he started noticing weakness in right shoulder movement after the recovery. The symptoms worsened and he visited rehabilitation unit two months later for further evaluation of the symptoms. On initial assessment, he had difficulty at shrugging and abduction of right shoulder. At right side, lateral winging scapula and trapezius muscle atrophy was also observed. Other clinical signs of lower cranial neuropathy (hoarseness, dysarthria, difficulties swallowing) did not appear and no sensory symptoms was involved.
Brain CT taken at the time of the accident had contusional hemorrhage of the right anterior temporal fossa and subarachnoid hemorrhage, and fracture of the base of skull extending to the jugular foramina. No abnormal findings were observed on cervical spine X-ray. Electromyography study revealed positive sharp waves and fibrillation potential in the right trapezius muscle and positive sharp waves in the right SCM muscle. The interference pattern showed discrete at both trapezius and SCM muscles. Right cranial XI palsy was confirmed based on the collective findings.
The patient underwent physical therapy for right shoulder weakness. The patient had education for stretching and strengthening exercises. At three month follow-up, clinically right shoulder weakness and range of motion improved and electromyography revealed mild improvement with no abnormal spontaneous activity in trapezius, SCM muscles.
Since patients traumatic brain injury could be affected, skull fracture should be considered in patients with isolated cranial XI nerve injury. |
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