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Cranial Nerves

Accessory Nerve Exam

February 15th, 2021

Accessory Nerve Muscular Weakness

  • How to Elicit

  • Sternocleidomastoid - ask the patient to turn their head against resistance.A CN XI lesion may cause weakness on head turning away from side of lesion
  • Trapezius - ask the patient to shrug their shoulders against resistance.An CN XI lesion may cause weakness in shoulder elevation on ipsilateral side
  • Causes of Accessory Nerve Muscular Weakness

  • Upper motor neuron  brainstem or cervical spinal cord
  • Lower motor neuron - accessory (XI) weakness
  • Interpretation

  • Isolated Trapezius WeaknessVentral brainstem, lower cervical spinal cord or lower accessory nerve lesion
  • Isolated Sternocleidomastoid WeaknessBrainstem or upper cervical lesion
  • Weakness of Trapezius and Contralateral SternocleidomastoidUpper motor neurone lesion on the side of the SCM weakness, above the accessory nucleus
  • Weakness of Ipsilateral TrapeziusContralateral brainstem, ipsilateral high cervical cord, or accessory nerve lesion
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