1305 - A Unique Presentation of Dropped Head Syndrome in a Parkinson’s Disease Patient: A Case Report

She reported progressive neck flexion over the past three years associated with neck stiffness, but denied headache, weakness, paresthesia, or sensory deficits. Physical exam revealed significant neck flexion, cervical kyphosis, right trapezius elevation, and visible atrophy of the posterior neck musculature. Active range of motion (ROM) was preserved in all directions except extension, which was limited to 30 degrees from the chest; however, passive ROM was intact in all planes, including extension. Strength, sensation and reflexes were normal. Additional findings related to her baseline PD included hypophonia, shuffling gait, and bradykinesia. Based on the history and physical exam, there was concern for Dropped Head Syndrome (DHS) secondary to cervical extensor muscle weakness. A cervical MRI was ordered to rule out spinal pathology, a Headmaster cervical collar prescribed, physical therapy was recommended, and home exercises were provided. 

Discussions: DHS is a rare disorder characterized by neck flexion due to weakness of the neck extensor muscles. It has been associated with neuromuscular disorders, myopathies, and central neurological disorders such as PD. DHS can present similarly to cervical dystonia (CD), which involves involuntary muscle contractions of the cervical muscles leading to abnormal neck postures. However, CD often presents with significant pain, tremors, and sensory tricks, which were absent in this patient. Treatment for DHS typically consists of treating any underlying conditions (e.g., PD in this patient), physical therapy, orthotics, and surgery in extreme cases.

Conclusions:

This case illustrates a rare instance of DHS in a Parkinson's patient. It is crucial to accurately differentiate between cervical dystonia and “pseudodystonias” such as DHS, as their management approaches have significant differences.