General Management Goals

Patients with dysfunction of either CN XI or CN XII may exhibit a number of problems with communication, swallowing, and well as difficulty resulting from weakness of the neck or trapezius muscle. Difficulty with swallowing may be amenable to swallowing therapy, including oral excercises and methods of postural facilitation. A soft mechanical diet with thickened liquids may decrease the likelihood of tracheal aspiration; however, a nasogastric tube or even a percutaneous gastrostomy device may be required.

Difficulty with articulation and communication may be amenable to speech therapy; however, augmentive and alternative communication devices may be required. Devices vary from the simple (e.g., boards with letters, words, or symbols), to the more complex (e.g., electronic communicators).

Weakness of the neck may be aided by a cervical orthotic device, and that, as well as weakness of the trapezius, may be aided by conventional physical therapy techniques such as range of motion and strengthening excercises, compensatory

TABLE 14-3 -- SELECTED ETIOLOGIES ASSOCIATED WITH DISORDERS OF CRANIAL NERVE XI AND CRANIAL NERVE XII

Etiological Category

Specific Etiologies

Chapter

STRUCTURAL DISORDERS

Developmental

Platybasia (CN XII)

28

Syringobulbia (CNs Xl, XII)

Degenerative and compressive

Paget's disease

29

HEREDITARY AND DEGENERATIVE DISORDERS

Chromosomal abnormalities and neurocutaneous disorders

Neurofibromatosis (CN Xll)

S2

Movement disorders

Dystonia (CNs Xl, Xll)

S4

Huntingtons disease (CN XI)

Myoclonus (CN Xll)

Degenerative motor, sensory and autonomic disorders

Amyotrophic lateral selerosis (CNs Xl, XII)

SB

ACQUIRED METABOLIC AND NUTRITIONAL DISORDERS

Endogenous metabolic d

Paget's disease (CN Xll)

S8

sorders

Exogenous acquired metabolic disorders of the nervous system: Toxins and illicit drugs

Botulism (CN Xll)

S9

INFECTIOUS DISORDERS

Viral infections

Acute poliomyelitis (CNs Xl, XII)

41

Nonviral infections

Tubercular meningitis (CN XII)

42

Neurosyphilis (CN Xll)

Brain stem abscess (CN Xll)

NEUROVASCULAR DISORDERS

Medial medullary syndrome (CN Xll)

45

Dissecting carotid aneurysm (CN Xll)

Cortical and subcortical vascular lesion (CN Xl)

Lateral pontine lesion (CN Xl)

NEOPLASTIC DISORDERS

Primary neurological tumors

Glomus cell tumor (CN Xll)

4B

Acoustic neuroma (CN XII)

Meningioma (posterior fossa) (CN XII)

Metastatic neoplasms and paraneoplastic syndromes

Metastatic carcinoma (CN XII)

47

DEMYELINATING DISORDERS

Demyelinating disorders of the central nervous system

Multiple sclerosis (CN Xll)

48

Demyelinating disorders of the peripheral nervous system

Guillain-Barre syndrome (CN Xll)

49

AUTOIMMUNE AND INFLAMMATORY DISORDERS

Neurosarcoidosis (CNs Xl, Xll)

50

TRAUMATIC DISORDERS

Basal skull fracture (CNs Xl, Xll)

51

Shoulder trauma (CN Xl)

Gun shot wound (CN XII)

Stab wound (CN Xll)

Dislocation of upper cervical vertebrae (CNs Xl, XII)

EPILEPSY

Focal epilepsy (CN Xl)

52

DRUG-INDUCED AND IATROGENIC' DISORDERS

Neck irradiation (CNs Xl, Xll)

55

Neck surgery (CNs Xl, XII)

Medications (neuroleptics) (CNs Xl, XII)

techniques, EMG feedback and functional electrical stimulation.

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