Neuritis refers to an inflammation of a nerve with pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. The XIth cranial nerve is also known as the accessory nerve. It supplies the trapezius and sternocleidomastoid muscles, and the pharynx. This cranial nerve is a motor nerve that acts to turn the head and shrug the shoulders.

In some cases, the cause of neuritis may be unknown. Identified causes may include: trauma; tumors; hemorrhage into a nerve; lesions; continuous pressure on a nerve; exposure to cold or radiation; viruses; or infectious disease such as Lyme disease. Other contributing causes include: systemic malignancy; leprosy; metabolic disease such as diabetes mellitus; collagen blood disorders; toxic agents; certain medications; nutrition deficiencies; metabolic disorders such as alcoholism; and genetics.

Symptoms may vary depending on the form of neuritis and the location of the lesion along the nerve. Manifestations may include: neuralgia; hyperesthesia; paresthesia; dysesthesia; hypesthesia; anesthesia; drooping of the shoulders or winging of the scapula that is displaced toward the affected side; muscle atrophy; weakness; inability to rotate the head away from the affected side; paralysis; or lack of reflexes.

Diagnostic measures may include: complete history; physical and neurological examinations; motor tests; blood studies; spinal tap; computed tomography (CT) scan; and magnetic resonance imaging (MRI); and electromyography (EMG).

Treatment may include management of the underlying disorder. Other aspects of treatment include: medications for pain; anti-inflammatory drugs; antibiotics; vitamin therapy; and physical therapy. Nutritional intervention and other treatments for involvement of affected neighboring nerves may be indicated.

Regeneration of the nerve may depend on the degree and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Although most patients recover, accessory neuropathies may be recurrent, and there may be injury to neighboring nerves. There may be an alteration in activities of daily living (ADL), and a need for long-term pain management. The potential for paralysis of the nerve exists.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• Dependent upon loss of motor function of sternomastoid and trapezius muscles.

• Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor.

• Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. (38 CFR 4.123)