SPASM OF THE SPINAL ACCESSORY NERVE. 353 



CHAPTEE XVI. 



SP^SM IN THE REGION OP THE SPINAL ACCESSORY NERVE OP WILLIS. 



ETIOLOGY. Like the facial, the accessory nerve of Willis is some* 

 times the seat of morbid irritability. The pathogeny and etiology of 

 this condition are as obscure as are those of tic convulsif. Violent 

 twisting of the neck, cold, disease of the cervical vertebras, have been 

 the assigned causes. The nodding spasm, or salaam convulsions, seen 

 in children, particularly at the period of dentition, does not seem to be a 

 genuine affection of the spinal accessory nerve and the cervical nerves. 

 Indeed, from its complications and course, it seems probable that it is 

 symptomatic of cerebral disease, or of an eclampsia. 



SYMPTOMS AND COURSE. Morbid excitement of the spinal acces- 

 sory nerve is manifested by spasm, either of a tonic or clonic character, 

 in the muscles supplied by that nerve, the trapezius, and the sterno- 

 cleido-mastoideus. 



In the former 'case, in each paroxysm, the head is drawn obliquely 

 downward several times in succession, the occiput approaching the 

 shoulder, and the ear the clavicle. The direction assumed by the head 

 is more forward or backward, according as the contractions are greater 

 in the trapezius or sterno-cleido-mastoideus. In the same way the 

 shoulder-blades and shoulders are drawn up during- the contractions of 

 the trapezius. If the irritation spread to the facial, the face twitches 

 also; if it involve the portio minor of the trigeminus, the jaws are 

 convulsively set. If the cervical nerves be also implicated, the head 

 is twisted, and the arms are thrown into convulsive agitation. Such 

 paroxysms, which are usually accompanied by pain in the muscles or 

 their attachments, usually last but for a second or two. At the outset 

 of the disease the attacks are less frequent ; as it advances, they recur 

 oftener ; so that as many paroxysms as thirty may occur in a minute, 

 driving the patient almost to desperation (JETasse). They do not come 

 on during sleep. These clonic spasms of the region of the accessory 

 nerve generally develop in a very slow and gradual manner. They 

 rarely cease, but, as a rule, endure through life, without endangering it. 



The term " salaam convulsion " of children is applied to solitary 

 or periodically-recurring paroxysms of clonic spasm of both sterno- 

 mastoid muscles, whereby the child is made to nod its head incessantly, 

 like a Chinese image. The nodding is very rapid, and sometimes in- 

 creases in rapidity as the attack goes on, making occasionally eighty 

 to a hundred nods a minute. Generally speaking, the muscles 

 of the face, especially the orbicularis palpebrarum, sympathize in the 

 movement. Epilepsy and idiocy develop in some children affected 



