Neuralgia refers to a severe sharp pain, which occurs along the course of a nerve. The XIth cranial nerve, also known as the accessory nerve, is one of twelve pairs of nerves connected with the brain. 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 neuralgia may be unknown. Identified causes may include: injury or irritation to the nerve; nerve root compression by a blood vessel or tumor; viral infections; chronic degenerative diseases such as multiple sclerosis; toxins; and infections.

Signs and symptoms may occur at irregular intervals with attacks characterized by unilateral, sharp, stabbing, or constant burning pain. Manifestations may include: 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; magnetic resonance imaging (MRI); and electromyography (EMG).

Treatment may depend on the underlying cause, and may include medications for pain, and peripheral nerve blocks if pain medication fails. Physical therapy may be useful for certain types of neuralgia. Surgical resection may be necessary when medical therapy fails.

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 also be injury to neighboring nerves. Frequency of attacks may vary with periods of long remissions. However, remission periods may decrease with age. Continuous bouts may be incapacitating and may alter activities of daily living (ADL). There may be a need for long-term pain management. Medications may warrant ongoing liver and blood studies. 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].

• None.