Late appearance of dropped head syndrome after radiotherapy for Hodgkin's disease

Abstract

We present three cases of dropped head syndrome that occurred as a complication of mantle field (i.e., lymph nodes of the neck, axillae, and mediastinum) or whole-body radiation therapy for Hodgkin's disease. These cases are characterized by a late onset (2-27 years after radiation treatment), fibrosis, and contraction of the anterior cervical muscles, and atrophy of the posterior neck and shoulder girdle. This report adds to the increasing literature about the late neurological complications of radiation therapy and describes a previously unrecognized cause of dropped head syndrome.

Radiation-induced camptocormia and dropped head syndrome

“…In total, two case reports (n = 2 patients) on radiogenic camptocormia [5][6] and nine reports about radiation-induced DHS (n = 45 patients) were retrieved [7][8][9][10][11][12][13][14][15]. Table 1 summarizes all the cases of radiotherapy-induced DHS and camptocormia and the radiation techniques used.…”

“…In fact, camptocormia was first described in soldiers as a psychogenic disorder [4]. Additionally, there are published reports about radiationinduced camptocormia [5][6] and DHS [7][8][9][10][11][12][13][14][15].…”

Pain Control in Head and Neck Cancer

“…An example is "dropped head syndrome", described by Rowin et al in 2006 as one potential complication of radiation of the mantle field (neck, axillary and mediastinal lymph nodes). This is a late complication of radiotherapy, characterised by fibrosis and contractures of the anterior cervical muscles and atrophy of the posterior neck and shoulder girdle.…”

Myopathy in Post-Radiation Cervico-Scapular Syndrome

“…Onset of these symptoms typically occurs from two to thirty years after radiation. 3,10 We present a patient with unusual features both on clinical exam and pathologic studies. Muscle biopsies revealed nemaline rod myopathy along with inflammatory changes, as well as the presence of myofiber necrosis suggestive of necrotizing myopathy in and outside the radiation portal, suggesting that perhaps not only muscles that are directly radiated are damaged.…”