Dysphagia and Dysphonia Secondary to Traumatic Vagus and Spinal Accessory Neuropathy

J Korean Assoc EMG Electrodiagn Med 2007;9(1):83-88.
Published online May 10, 2007.

Abstract

Dysphagia was very serious problem caused by trauma, cerebrovascular accidents or degenerative disease in rehabilitation unit, and the patient with dysphagia often present with a hoarse, breathy voice as well as symptom of aspiration. The patient with vagus neuropathy had incoordination of cricopharyngeus that causes formation of the pocket or aspiration. Spinal accessory nerve lies in the same sheath as the vagus nerve, and there was some possibility of concomitant injury. The following patient had traumatic vagus and spinal accessory neuropathy by accidental trauma and had no abnormality of imaging studies. He had symptoms of dysphagia, dysphonia, and weakness of upper trapezius and sternocleidomastoid. The amplitude of compound motor action potential of left spinal accessory nerve was decreased and latency was delayed, too. The abnormal spontaneous activity was shown in the vagus nerve-innervated and spinal accessory nerve-innervated muscles. The videofluoroscopic swallowing study was shown severe subglottic aspiration. We recommended percutaneous endoscopic gastrostomy for swallowing training and speech treatment. At 6 months later, he took a soft diet himself by compensation technique. Also he had mild hoarseness. But Weakness of sternocleidomastoid and upper trapezius was continued. We report a case of vagus and spinal accessory neuropathy by accidental trauma.

Key Words: Vagus nerve, Spinal accessory nerve, Dysphagia, Dysphonia