A case of unilateral idiopathic accessory nerve palsy is described.
A 45-year-old woman sought medical help in July 1994 because of dysphagia and hoarseness, and was diagnosed as having recurrent nerve paralysis. Several days later she developed severe pain in the left side of her neck and shoulder. Despite the pain subsiding over several days, she noticed increasing difficulty in elevating her left arm.
Physical examination two months following the onset of the illness showed obvious atrophy of the trapezius muscle and mild atrophy of the sternocleidomastoid muscle on the left side. She was unable to abduct her arm above the horizontal position. Electrophysiological evaluations demonstrated slowing of the accessory nerve conduction and evidence of denervation of the trapezius muscle. Hematological evaluations showed slightly increasing white blood cells and herpes simplex viral titer. The remainder of the examinations were normal.
On the basis of the above findings, it was possible to diagnose Schmidt syndrome due to idiopathic accessory nerve palsy. A trial of conservative treatment for a year produced a significant improvement. This syndrome should be considered in the differential diagnosis of shoulder gridle weakness and impairment.
