Too Much of a Good Thing

A 70 yo former star athlete (tennis, golf, swimming, track) in both high school and college, spent the rest of his schooling years drinking, smoking and being the life of the party. He was the invincible one. In fact, it was not uncommon for the athlete to smoke two packs a day, enjoy several martinis at lunch, followed by Manhattans at dinner. Of course, there was also afternoon libations to bridge time between meals. Surprisingly, the athlete did not gain weight, presented in generally good health, and was an accomplished lawyer at a power-house firm in New York City. Until, at his seventieth birthday party, he suffered a mild stroke and was rushed to the ED where his carotid arteries were diagnosed to be approximately 80% blocked by plaque. Having weathered the stroke, an endarterectomy was scheduled for the following week. No signs of complications were noted in the recovery room, although the incision was expanded some when it was noted that the plaque extended somewhat more inferiorly than customary.   At two days post operation, the septuagenarian is still unable to turn his head opposite to the side where the incision was made, but he can turn it just fine to the side of the lesion. At two weeks, he is still unable to turn his head and now his head slumps to the side of the incision. The surgeon tells him the condition is likely to be permanent, that a major nerve was likely injured during the surgery. Which of the labeled nerves in the image was likely severed during the surgery?

Unfortunately for the surgeon, our former star athlete’s law firm focuses on litigating iatrogenic injuries.

What likely nerve has been injured in this patient?

A.1

B.2

C.3

D.4

E.5