Cervical myelopathy caused by dropped head syndrome

Abstract

<jats:p>✓The authors present a rare case of cervical myelopathy caused by dropped head syndrome. This 68-year-old woman presented with her head hanging forward. After 1 month, she was admitted to the medical service because of head drop progression. Examination of biopsy specimens from her cervical paraspinal muscles showed nonspecific myopathic features without inflammation, and isolated neck extensor myopathy was diagnosed. The patient’s condition did not respond to the administration of corticosteroids. During follow up as an outpatient, the patient’s head drop continued to gradually progress. At 1 year after onset, she developed bilateral weakness of the upper and lower extremities, clumsiness of the hands, and gait disturbance. A radiograph of the cervical spine obtained in a standing position showed a pronounced kyphotic deformity and instability at the level of C4–5. Magnetic resonance imaging demonstrated spinal cord compression at C-3 and C-4. The patient underwent a C3–4 laminectomy and occipitocervicothoracic fixation. Gait and hand coordination gradually improved, and she was able to walk with no support 1 month postoperatively. Surgical fixation was beneficial in this patient with dropped head syndrome, myelopathy, and cervical instability.</jats:p>

Cervical Spine Instability following Resection of Benign Intradural Extramedullary Tumours in Children

“…Besides, large IDEM tumours can damage the facets, pedicles and ligaments like the anterior longitudinal and interspinous ligaments themselves and cause instability. The weakness of posterior neck muscles due to neurogenic, pre- and postsurgical factors is akin to a dropped head syndrome causing cervical kyphosis [12]. …”

Upper Thoracic Myelopathy Caused by Delayed Neck Extensor Weakness in Myotonic Dystrophy

“…Although commonly considered a benign condition by itself, patients ordinarily complain of head drop, neck pain, and limited activities because the patient can only look downward 5. The dropped head is primarily due to excessive tension in the anterior cervical muscles associated with weakness or atrophy of the posterior cervical muscles.…”

The “Baseball Cap Orthosis”

“…This further compromises the patient's function. 10 Beyond pharmacological intervention, when appropriate (steroids, intravenous immunoglobulin), conservative care is limited to strengthening exercises, cervical collars, and, in patients with fixed flexion contracture, cervical traction with a halo apparatus. 11 These treatment options are often unsatisfactory and may be frustrating to both clinician and patient alike.…”