Spinal accessory nerve injury: eight cases and review of the literature.

The spinal accessory nerve (SAN) is the major motor supply to the trapezius and sternocleidomastoid muscles. The superficial course of the SAN in the posterior cervical triangle makes it vulnerable to injuries. The most common reason is an iatrogenic injury during surgery but other causes such as stretch or traction injury have also been reported. Five iatrogenic SAN injuries were occurred after radical neck dissection (RND) for laryngeal carcinoma in two patients, lymphadenectomy for oral mucosal tumor in one patient, surgery for lipoma in one patient, and lymph node biopsy for tuberculosis in one patient, traumatic SAN injuries were occurred after the carrying and lifting in three patients. Our eight patients were followed conservatively and 6 of them had significant improvement of pain and function of the shoulder. However, the remaining two patients with radical neck dissection showed moderate improvement in both pain and function including shoulder range of motion and activities of daily living. We report the eight cases with SAN injury that had admitted to our outpatient clinic in the last one year with neck, back and shoulder pain as well as limitation in the shoulder range of motion and difficulty in the activities of daily living.

Cerebral microhemorrhages detected by susceptibility-weighted imaging in amateur boxers.

BACKGROUND AND PURPOSE: SWI is a new technique for evaluating diffuse axonal injury associated with punctate hemorrhages. The aim of our study was to determine the prevalence of cerebral microhemorrhages in amateur boxers compared with nonboxers by using SWI and to evaluate the sensitivity of SWI compared with T2 FSE and T2*GE sequences. MATERIALS AND METHODS: We performed cranial MR imaging with a 1.5T scanner in 21 amateur boxers and 21 control subjects. The study protocol included conventional MR images, T2 FSE, T2*GE, and SWI sequences. The proportions of boxers and controls having CSP, DPVS, cerebral atrophy, cerebellar atrophy, ventricular dilation, PSWMD, and microhemorrhages were computed and were compared by using the χ(2) test of proportions. The relationship between microhemorrhages and boxing-related covariates was assessed by using the Wilcoxon rank sum test. The association between the categories was tested by using the Fisher exact test. RESULTS: Using SWI, microhemorrhages were found in 2 (9.52%) of 21 boxers. The microhemorrhages were not visible on T2 FSE or T2*GE images. The proportion of subjects with microhemorrhages did not differ significantly between the boxers and control subjects (χ(2) = 0.525, df = 1, P = .4688). The prevalence of CSP and DPVS was significantly higher in the boxers than in the control subjects. CONCLUSIONS: More microhemorrhages were detected in amateur boxers than in controls, but this difference was not statistically significant.