A practical approach to the patient presenting with dropped head

Cauchi, Marija; Marsh, Eleanor

doi:10.1136/practneurol-2016-001450

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…Dropped head syndrome (DHS) is an uncommon condition in which patients present with a disabling inability to lift their head. It may arise in many neurological conditions and can be further divided into two categories: increased tone of the neck flexors (neck dystonia) or weakness of neck extensors associated with inflammatory myopathies (IMs) ( 1 ) including polymyositis or inclusion body myositis (IBM) ( 2 ). A histopathological hallmark of IBM is the presence of rimmed vacuoles (RVs) reflecting an impaired autophagy process.…”

Section: Introductionmentioning

confidence: 99%

Dropped Head Syndrome and the Presence of Rimmed Vacuoles in a Muscle Biopsy in Scleroderma-polymyositis Overlap Syndrome Associated with Anti-Ku Antibody

Yoshida

Kinjo

et al. 2018

Intern. Med.

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A 66-year-old woman with a history of interstitial lung disease presented with a 3-month history of dropped head syndrome (DHS), followed by camptocormia and extremity weakness. A clinical examination revealed Raynaud phenomenon, arthralgia, distal skin sclerosis, and microbleeds in the nailfold capillaries. An anti-Ku antibody test was positive. A muscle biopsy revealed inflammatory myopathy with rimmed vacuoles (RVs). The diagnosis of scleroderma-polymyositis (SSc-PM) overlap syndrome was made. RVs on a muscle biopsy in a patient with inflammatory myositis involving axial muscles may be seen either in inclusion body myositis or SSc-PM overlap syndrome. The examination of the skin and autoantibody testing help determine the diagnosis and treatment strategy.

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Section: Introductionmentioning

confidence: 99%

Dropped Head Syndrome and the Presence of Rimmed Vacuoles in a Muscle Biopsy in Scleroderma-polymyositis Overlap Syndrome Associated with Anti-Ku Antibody

Yoshida

Kinjo

et al. 2018

Intern. Med.

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“…Dropped head syndrome has various causes including neuromuscular disorders, imbalance in neck muscle tone, and skeletal problems 1 . To the best of our knowledge, this is the first report of dropped head due to extreme cervicothoracic kyphosis caused by the metastatic vertebral collapses.…”

Section: Figurementioning

confidence: 77%

Dropped head syndrome due to vertebral metastasis of breast cancer

Itô

Okamoto

2020

Neurology & Clinical Neurosc

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“…MG can present with head‐drop, particularly in MuSK‐positive cases and in the elderly . Identifying any diurnal variation in symptoms can be important: patients with neuromuscular junction illness, such as MG, might notice weakness at the end of the day or after exertion, but regain normal strength by the next morning …”

Section: Symptomsmentioning

confidence: 99%

Management of myasthenia gravis in daily practice for general neurologists and healthcare professionals

Yokoyama

2017

Clinical & Exp Neuroim

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A characteristic feature of myasthenia gravis (MG) is the fluctuating weakness of the muscles. MG is an autoimmune neuromuscular junction disorder mediated by autoantibodies against nicotinic acetylcholine receptor and muscle-specific tyrosine kinase. If the commercially available acetylcholine receptor and muscle-specific tyrosine kinase antibody test is negative, MG patients are termed as having double-seronegative MG. Although the clinical phenotype is not yet defined, antibodies for lipoprotein receptor-related protein 4 and agrin, involved in clustering of acetylcholine receptors within the postsynaptic membrane and in structural maintenance of the neuromuscular synapse, have been found. The updated 2014 Guidelines in Japan state that the management of MG should be individualized, and earlier aggressive treatment using steroid pulse, plasma exchange and intravenous immunoglobulin therapy, before long-term steroid therapy, should be used in order to minimize manifestation, with fewer adverse effects achieved by co-administering immunosuppressants. In 2016, thymectomy was shown to be efficacious in non-thymomatous MG in a single-arm randomized clinical trial. The continuous update and modification in MG management makes it difficult for the general neurologist to decide on a treatment strategy. The present review aims to improve the understanding of current MG diagnosis, specific immunotherapy and clinical management tips, not only for the general neurologist, but also for other medical staff.

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A practical approach to the patient presenting with dropped head

Cited by 13 publications

References 30 publications

Dropped Head Syndrome and the Presence of Rimmed Vacuoles in a Muscle Biopsy in Scleroderma-polymyositis Overlap Syndrome Associated with Anti-Ku Antibody

Dropped Head Syndrome and the Presence of Rimmed Vacuoles in a Muscle Biopsy in Scleroderma-polymyositis Overlap Syndrome Associated with Anti-Ku Antibody

Dropped head syndrome due to vertebral metastasis of breast cancer

Management of myasthenia gravis in daily practice for general neurologists and healthcare professionals

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