3 free views remaining today
dropped head syndrome
ICD-10 Codes
Related ICD-10:
Description
Dropped Head Syndrome (DHS): A Rare Condition
Dropped head syndrome, also known as DHS, is a rare condition characterized by severe weakness of the muscles in the back of the neck. This leads to an inability to maintain the head in an upright posture, causing the chin to rest on the chest [7].
Causes and Symptoms
The affected muscles appear atrophic, edematous, and replaced by fat, as revealed by MRIs [3]. Common causes of DHS include severe weakness of the cervical paraspinal muscles, which can be associated with weakness of the shoulder girdle [4].
DHS is often characterized by a sudden onset, with some cases presenting within 3 days from the time of awareness of cervical weakness [6]. The condition results in a progressive and reducible kyphosis (curvature) of the cervical spine.
Key Features
- Severe weakness of the neck extensor muscles
- Inability to maintain the head in an upright posture
- Chin resting on the chest
- Atrophic, edematous, and fatty replacement of affected muscles (as seen on MRIs)
- Associated with a wide spectrum of myopathies
References
[1] AR Martin (2011) - Cited by 80 [2] AD Sharan (2012) - Cited by 95 [3] MRIs reveal atrophic, edematous, and fatty replacement of affected muscles [4] Dropped head syndrome is a rare condition characterized by severe weakness of neck extensors [5] Dropped Head Syndrome is characterized by severe weakness of the muscles of the back of the neck [6] Sudden-onset DHS was defined as presenting with chin on chest deformity within 3 days from the time of awareness of cervical weakness [7] “Dropped head syndrome is manifested as the inability to maintain the head in an upright posture. [8] Dropped Head Syndrome is characterized by severe weakness of the muscles of the back of the neck.
Additional Characteristics
- Severe weakness of the muscles in the back of the neck
- Inability to maintain the head in an upright posture, causing the chin to rest on the chest
- Atrophic, edematous, and replaced by fat appearance of affected muscles as revealed by MRIs
- Progressive and reducible kyphosis (curvature) of the cervical spine
- Severe weakness of the neck extensor muscles
- Associated with a wide spectrum of myopathies
Signs and Symptoms
Dropped Head Syndrome (DHS) Signs and Symptoms
Dropped head syndrome, also known as "chin on chest" deformity, is a rare condition characterized by the gradual weakening of the muscles in the back of the neck. This leads to a range of symptoms that can significantly impact an individual's quality of life.
Common Symptoms:
- Chin on Chest Posture: The most distinctive symptom of DHS is the forward bending or flexion of the head, resulting in the chin resting on the chest.
- Weakness and Atrophy: Weakness and atrophy (shrinkage) of the neck muscles, particularly the extensors, are common symptoms.
- Pain: Posterior cervical pain, which is a type of pain in the back of the neck, can be an early manifestation of DHS.
- Muscle Spasms and Tightness: Muscle spasms and tightness in the neck and shoulder region may also occur.
- Difficulty Maintaining Forward Gaze: Individuals with DHS may experience difficulty maintaining a forward gaze or looking up.
Other Possible Symptoms:
- Upper motor neuron signs, such as muscle weakness, loss of muscle control, and spasms
- Muscle atrophy
- Skin changes
- Ocular or bulbar weakness
- Facial weakness
- Selective weakness patterns
- Pelvic girdle weakness
These symptoms can vary in severity and may develop over a period of one week to three months. It's essential to note that DHS is often painless, and the symptoms may not be immediately apparent.
References:
- [1] Dropped head syndrome (DHS) is known as a “chin on chest” deformity. This deformity has significant implications on the health and quality of life of affected individuals.
- [2] Excessive strain on the neck extensors leads to posterior cervical pain, which is a common early manifestation.
- [4] Dropped head syndrome: You may have severe cervicothoracic kyphotic deformity (Hunchback deformity).
- [10] Understanding Dropped Head Syndrome: Symptoms, Causes, and Treatment. Dropped head syndrome (DHS) causes a recognizable deformity with varying degrees of “chin on chest” posture.
- [14] The symptoms of Dropped Head Syndrome are usually painless. It most often occurs in the elderly.
Please note that these references are based on the provided context and may not be an exhaustive list of all possible symptoms or information related to dropped head syndrome.
Additional Symptoms
- Skin changes
- Chin on Chest Posture
- Weakness and Atrophy
- Difficulty Maintaining Forward Gaze
- Upper motor neuron signs, such as muscle weakness, loss of muscle control, and spasms
- Muscle atrophy
- Ocular or bulbar weakness
- Pelvic girdle weakness
- facial weakness
- muscle tightness
- pain
- weakness
Diagnostic Tests
Dropped Head Syndrome (DHS) is a rare condition that affects the muscles of the neck and head, leading to a characteristic drooping posture. Diagnostic tests for DHS are crucial in ruling out other conditions and confirming the diagnosis.
Initial Evaluation
The diagnostic process begins with a complete history and physical examination [3][6][7][8]. This involves gathering information about the patient's symptoms, medical history, and performing a thorough physical examination to assess muscle strength, reflexes, and skin sensation [9].
Diagnostic Tests
Several tests may be performed to confirm the diagnosis of DHS:
- Blood tests: To rule out other conditions such as myasthenia gravis (MG) or inflammatory myopathies. Patients with DHS should be tested for MuSK antibody titer, as some cases are associated with this condition [4].
- Prone position cervical extension test (DHS test): A novel diagnostic examination specifically designed to diagnose DHS [2].
Eliminating Other Conditions
Neurologists use a series of tests to eliminate other conditions before making a definitive diagnosis of MND (Motor Neuron Disease), which includes DHS. These tests may include:
- Blood tests to look for antibodies associated with MG or inflammatory myopathies [5].
- A physical examination to assess muscle strength, reflexes, and skin sensation.
Supportive Treatment
The treatment of Dropped Head Syndrome is mainly supportive, focusing on managing symptoms and improving quality of life. Physical therapy plays a crucial role in maintaining muscle strength and mobility [3][6][7][8].
References:
[1] AR Martin (2011) - Cited by 81 [2] H Sano (2023) [3] Diagnosis begins with a complete history and physical exam. [4] Even tongue fasciculations are reported in cases with MuSK MG. Patients with dropped head syndrome should be tested for MuSK antibody titer. [5] Neurologists use a series of tests to eliminate other conditions before making a definitive diagnosis of MND. [6] Diagnosis begins with a complete history and physical exam. [7] Once your diagnostic examination... [8] treatment of Dropped Head Syndrome is mainly supportive. [9] We will do a physical examination to test your reflexes, skin sensation, muscle strength.
Additional Diagnostic Tests
- Blood tests
- Prone position cervical extension test (DHS test)
- MuSK antibody titer
Treatment
Dropped Head Syndrome (DHS) can be treated with various methods, including drug treatment.
Medications for DHS
According to the search results, an increase in the dosage of l-dopa and a decrease in that of the dopamine agonist should be considered for the treatment of DHS in parkinsonian patients [1]. This suggests that medications such as l-dopa may be used to treat DHS, particularly in patients with Parkinson's disease.
Additionally, corticosteroids have been mentioned as an immune-modulating therapy for treating isolated neck extensor myopathy (INEM), which is a condition associated with DHS [7]. However, it is essential to note that the primary treatment for DHS typically involves conservative measures such as cervical orthosis and physical therapy.
Other Treatment Options
It's worth noting that while medications may be used in conjunction with other treatments, they are not the only solution for correcting and stabilizing DHS. Surgical intervention involving multilevel instrumented fixation and fusion is considered the definitive solution for correction and stabilization of DHS [2].
In some cases, prolotherapy (a regenerative injection technique) has been referred to as a treatment option for various conditions, including those associated with DHS [4]. However, its effectiveness in treating DHS specifically is unclear.
Summary
To summarize, while medications such as l-dopa and corticosteroids may be used in the treatment of DHS, particularly in patients with Parkinson's disease, they are not the only solution. Conservative measures like cervical orthosis and physical therapy are typically the primary treatment approach. Surgical intervention remains the definitive solution for correction and stabilization of DHS.
References:
[1] Oyama G (2009) - For the treatment of DHS in parkinsonian patients, an increase in the dosage of l-dopa and a
Recommended Medications
- corticosteroids
- L-dopa
- Levodopa
- dopamine agonist
💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.
Differential Diagnosis
Differential Diagnosis of Dropped Head Syndrome
Dropped head syndrome (DHS) is a rare condition characterized by severe kyphotic deformity of the cervico-thoracic spine. The differential diagnosis for DHS is broad and includes various neurological, neuromuscular, muscular, and other causes.
Common Causes:
- Amyotrophic Lateral Sclerosis (ALS): Also known as Motor Neurone Disease, ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. It occurs among 1-3% of individuals diagnosed with ALS [4].
- Myasthenia Gravis: A chronic autoimmune disorder that leads to muscle weakness and fatigue.
- Facioscapulohumeral Muscular Dystrophy: A genetic disorder that affects muscles in the face, shoulders, and upper arms.
- Polymyositis: An inflammatory muscle disease that causes progressive muscle weakness.
- Myotonia Congenita: A rare genetic disorder that affects muscle tone and leads to stiffness and weakness.
Other Causes:
- Isolated Neck Extensor Myopathy: The most common cause of DHS, accounting for 31.8% of cases [8].
- Parkinson's Disease: A neurodegenerative disorder that can lead to muscle rigidity and weakness.
- Amyotrophic Lateral Sclerosis (ALS): In addition to ALS, other forms of motor neuron disease may also be associated with DHS.
Symptoms:
- Neck pain
- Difficulty eating
- Impaired horizontal gaze
These symptoms are often accompanied by a significant kyphotic deformity of the cervico-thoracic spine. It is essential to differentiate DHS from other conditions that may present with similar symptoms, such as isolated neck extensor myopathy or Parkinson's disease.
References:
[1] AR Martin (2011) - Dropped head syndrome (DHS) is a relatively rare condition with a broad differential diagnosis. [2] AZ Burakgazi (2019) - DHS is relatively rare and may occur as a result of several neurological, neuromuscular, muscular, and other causes. [3] AR Martin (2011) - Dropped head syndrome (DHS) has significant implications on the health of affected individuals. [4] Context 4 [5] R Alhammad (2018) - Choosing the correct diagnosis for DHS is crucial to avoid treatment delay and significant morbidity. [6] AR Martin (2011) - Dropped head syndrome (DHS) is a relatively rare condition, with a broad differential diagnosis. [7] Context 7 [8] Context 8
Additional Differential Diagnoses
- Isolated Neck Extensor Myopathy
- Parkinson's disease 4
- facioscapulohumeral muscular dystrophy 3
- polymyositis
- amyotrophic lateral sclerosis
- myotonia congenita
- myasthenia gravis
Additional Information
- relatedICD
- http://example.org/icd10/T38.815
- oboInOwl#hasOBONamespace
- disease_ontology
- oboInOwl#id
- DOID:0060034
- oboInOwl#hasExactSynonym
- floppy head syndrome
- IAO_0000115
- A spinal disease that is characterized by severe kyphotic deformity of the cervicothoracic spine and by severe weakness of the cervical paraspinal muscles that results in the passively correctable chin-on-chest deformity. This syndrome is defined by weakness of neck extensor muscles against gravity with or without weakness of neck flexor muscles.
- rdf-schema#domain
- https://w3id.org/def/predibionto#has_symptom_1067
- owl#annotatedSource
- t336106
- core#notation
- DOID:0060034
- rdf-schema#label
- dropped head syndrome
- rdf-schema#subClassOf
- http://purl.obolibrary.org/obo/DOID_0060564
- 22-rdf-syntax-ns#type
- http://www.w3.org/2002/07/owl#Class
Medical Disclaimer: The information provided on this website is for general informational and educational purposes only.
It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with questions about your medical condition.