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Nerve & Spinal Cord Injury
Neural structures at risk in the neck include the lower
cranial nerves, brachial plexus, phrenic nerve as well
as the spinal cord itself. A detailed neurological examination
must be carried out as physical signs may be subtle.
Many nerves run with vascular structures, and a nerve
injury may have an associated vascular injury.
Spinal column & spinal cord
Penetrating injuries to the neck do not require spinal
immobilisation. Stab injuries are not associated with
spinal instability. Gunshot wounds may rarely lead to
an unstable spine, but these are invariable associated
with complete cord transection.
Spinal nerve roots are more commonly injured than the
cord itself. Spinal cord laceration itself usually manifests
as a partial Brown-Sequard syndrome. This manifests
as ipsilateral loss of motor, proprioceptive and vibratory
functions, with contralateral loss of pain and temperature
sensation. However the neurological findings are rarely
as clear-cut as in the classic description of the syndrome.
Brachial plexus
Brachial plexus injuries are fairly common and a detailed
examination of limb neurology is essential. Again, there
may be an associated vascular injury and angiography
should be undertaken when there is a neurological deficit.
Cranial nerves
The lower branches of the facial nerve and the hypoglossal
nerve are at risk in upper cervical lesions. Injury
to the vagus is often only found at operation, but may
manifest as hoarseness due to recurrent laryngeal nerve
involvement.
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