In a series of 23 patients, the commonest cause of accessory nerve palsy was surgical trauma at the time of lymph node biopsy. The less common causes were penetrating or blunt trauma and a few were of spontaneous onset. There was involvement of adjacent motor sensory nerves in about half of the patients. The prognosis was better following blunt trauma, stretch injuries and after a spontaneous onset. The anatomical relationships of the accessory nerve and aspects of the clinical picture and management are discussed. RESUME: Paralysie du nerf spinal: revue de 23 cas. Dans une serie de 23 patients, la cause la plus frequente de paralysie du nerf spinal 6tait le traumatisme chirurgical au moment d'une biopsie d'un ganglion lymphatique. Parmi les causes plus rares, on notait les traumatismes penetrants ou contondants et quelques ces etaient spontanes. II existait une atteinte des nerfs moteurs ou sensitifs adjacents chez a peu pres la moitie des patients. Le pronostic etait plus favorable a la suite des traumatismes contondants, des blessures par 6tirement et lorsque le debut etait spontane. Nous discutons des relations anatomiques du nerf spinal, de certains aspects du tableau clinique et de la conduite du traitement.Can. J. Neurol. Sci. 1991; 18:337-341 Accessory nerve palsy commonly occurs as a result of a surgical trauma within the posterior triangle, 1 -2 -3 -4 -5 usually at the time of lymph node excision. 6 -7 -8 -9 It has also been described following carotid endarterectomy, 10 -11 accidental laceration, 7 irradiation 12 and as a spontaneous event. 13 This series is unusual as it contains a relatively large number of cases in which the trauma was of a non-surgical type.

Laryngeal atresia is a rare congenital anomaly requiring immediate tracheotomy as a lifesaving measure. A case of subglottic laryngeal atresia is reported and correlated with laryngeal embryogenesis. Three types of laryngeal atresia are described. Although tracheoesophageal fistula is commonly associated with laryngeal atresia, one must be careful not to confuse a pharyngotracheal duct with a tracheoesophageal fistula. A disproportionate number of reported TE fistulas associated with laryngeal atresia may result if an accurate distinction between pharyngotracheal duct and TE fistula is not made.

Sarcoidosis is a chronic, multisystem, granulomatous disease which typically develops between the ages of 20 and 40 years 1 . Neurosarcoidosis occurs in only 5-15% of adults with sarcoidosis, and is seldom reported in children [2][3][4][5] . Of the cases described in the literature, children were found more likely to present with seizures, and less commonly space-occupying lesions 6 . The tumefactive brain lesions are difficult to distinguish from the tumefactive demyelinating lesions of multiple sclerosis, from brain neoplasms, acute disseminated encephalo-myelitis (ADEM), or from parasitic foci 7,8 . We report the clinical and radiographic features of an 11-year-old boy with biopsy-proven neurosarcoidosis in order to highlight key features that distinguish neurosarcoidosis from tumefactive demyelination. CASE REPORTA previously healthy 11-year-old male presented in status epilepticus. The seizure started with an altered level of awareness and focal twitching of the right side of his face. The ictus lasted 45 minutes and responded to intravenous administration of lorazepam and phenytoin.Investigations revealed a peripheral white blood cell count of 28.2 (4.5-13 X10 9 /L), and normal hemoglobin and platelets. Electrolytes, glucose, renal and liver function, and coagulation parameters were normal. A toxicology screen was negative. Bacterial, viral, and fungal cultures were negative in blood. Cerebrospinal fluid (CSF) analyses revealed 20 X 10 6 /L leucocytes (90% lymphocytes), normal glucose and protein, no malignant cells, and negative bacterial and viral cultures. Polymerase chain reactivity for Herpes viruses was negative. Oligoclonal banding was detected, but as serum electrophoresis was not performed, this finding could not be evaluated. Serum anti-nuclear factor was negative.Computerized tomography of the head showed a focal, nonenhancing mass of the left frontal lobe with no evidence of mass effect or hydrocephalus. As shown in Figure 1, magnetic resonance imaging (MRI) demonstrated a region of increased T2/FLAIR signal involving the white matter of the left frontal lobe with leptomeningeal enhancement after gadolinium contrast administration. Magnetic resonance spectroscopy (MRS) demonstrated a lactate peak with normal choline and Nacetylaspartate. A second MRI obtained one week later showed improvement, with normalization of mass spectroscopy.Following recovery from the post-ictal period, the child was noted to have a normal neurological and general physical examination, including normal cognition and no focal deficits. Given the normal examination, and repeat MRI showing improvement in the lesion appearance, brain biopsy was THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES 783