Dropped Head Syndrome: A Case Series in an Internal Medicine Department

Background: Dropped head syndrome is a flexion of the head on the trunk secondary to a deficit of the cervical extensor muscles. It has been rarely reported in the literature.

Cases Presentation: We presented a case series of six patients with dropped head syndrome admitted during six months. All patients were female, and their median age was 30 years. All patients had a muscle deficit ≤ 2/5. Extra-muscular signs were constant. CPK levels ranged from 2.3 to 358.4 times normal. The diagnoses associated with dropped head syndrome were as follows: Dermatomyositis (two cases), Overlap myositis (one case), Anti-synthetase syndrome (one case), Thyrotoxic hypokalemic periodic paralysis (one case), Unclassified myositis (one case). Corticosteroid therapy was proposed in four patients. Potassium supplementation was done for the patient with hypokalemic paralysis. One patient did not receive any specific treatment. Methotrexate was started in one patient. The evolution was marked by death in three patients, favorable in two patients. One patient was lost to follow-up.

Conclusion: Dropped head syndrome, in our experience, was associated with a severe muscle deficit, a poor prognosis and inflammatory myopathies.

Keywords: Dropped Head Syndrome, Inflammatory Myopathies, Internal Medicine.