The dropped head sign in parkinsonism
Introduction
The peculiar neck flexion posture alternatively called ‘dropped head syndrome’ [1], ‘disproportionate antecollis’ [2], or ‘progressive head drooping’ [3], in which the head assumes an attitude of looking at the ground, is occasionally seen in some neurological diseases. It is known that this symptom can accompany two different conditions, neck extensor muscle weakness or parkinsonism. The former condition occurs in myasthenia gravis, motor neuron disease, polymyositis, dermatomyositis, facioscapulohumeral dystrophy, congenital myopathy, carnitine deficiency, chronic inflammatory demyelinating polyneuropathy, and isolated neck extensor myopathy [4]. The latter occurs in multiple system atrophy, diffuse Lewy body disease [5], and Parkinson’s disease [5], [6]. The pathophysiology of the dropped head sign in parkinsonism has not yet been made clear. Here, we here reviewed seven patients with parkinsonism who exhibited the dropped head sign.
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Patients and methods
The seven patients with parkinsonism studied here presented extreme flexion of the neck (Fig. 1). They included six females and one male ranging in age from 53 to 74 (Table 1). We investigated the relationship between the dropped head sign and their clinical courses, drug treatments, and other clinical symptoms. Surface EMG of the neck, in which electrodes were placed on the bilateral trapezius and sternocleidomastoid (SCM) muscles, was performed on three of the patients. The diagnoses of all
Clinical diagnosis and findings
Three patients were clinically diagnosed with Parkinson’s disease and the other four patients were diagnosed with multiple system atrophy (Table 1).
All patients had moderate to severe neck rigidity which was stronger than limb rigidity in all but patient 3. Anterior neck muscle spasms were not observed, but extensor muscle contractions were obvious in all cases. When patients attempted to extend the head voluntarily or passively muscle contraction of the SCM, which was not seen in the
Discussion
The dropped head sign in parkinsonism, which seems not to be caused by neck extensor muscle weakness, was reported by Quinn [2] under the name of ‘disproportionate antecollis.’ In that report, he suggested that the dropped head sign might be a relatively characteristic symptom of multiple system atrophy. Subsequently, additional reports were made of the dropped head sign in association with Parkinson’s disease and diffuse Lewy body disease [5], [6]. In keeping with these reports, our present
References (8)
Disproportionate antecollis in multiple system atrophy
Lancet
(1989)- et al.
Antecollis in parkinsonism
Lancet
(1989) - et al.
The dropped head syndrome
Neurology
(1992) - et al.
Clinical and neuropathological features of a neurodegenerative disorder in the central nervous system with progressive head drooping (kubisagari)
Acta Neuropathol.
(1995)
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2017, Journal of Orthopaedic SciencePramipexole-induced antecollis in patients with Parkinson's disease: Two cases and literature review
2015, eNeurologicalSciCitation Excerpt :The pathophysiology of antecollis in PD is unclear, but various different central mechanisms (dystonia, rigidity, proprioceptive disintegration) and peripheral processes (myopathy, skeletal and soft-tissue changes) have been proposed [1]. Dopamine agonists (DA) are known to induce or aggravate antecollis in PD [1,4–11,13], and it was found in 0.8% [4]. In addition, there were rare reports that amantadine and donepezil hydrochloride caused antecollis in Japanese patients with PD [12,14].
An <sup>18</sup>F-FDG PET study of cervical muscle in parkinsonian anterocollis
2014, Journal of the Neurological SciencesCitation Excerpt :The median modified Hoehn and Yahr scale was 3 [1–3] for PD and 4 for both MSA patients. The median duration of primary diagnosis from onset of symptoms to the date of the study evaluation was 10 years [5–13] for PD and 6 years [4–8] for MSA. The median duration of anterocollis from onset of symptoms to the study evaluation was 3.5 years [2–5] for MSA and 2 (0.2–13) years for PD.
Clinical subtypes of anterocollis in parkinsonian syndromes
2012, Journal of the Neurological SciencesCitation Excerpt :No effective therapy is available. Neck rigidity, weakness, limitations in range of motion, pseudohypertrophy of the neck extensors, and atrophy of the flexors have all been reported as characteristics of this condition [3,6,7]. Terms used to describe anterocollis in the literature include ‘head drop’ or ‘dropped head syndrome’ (DHS) which has been used to imply weakness as a cause [8–11], and ‘disproportionate anterocollis’ which has been used to imply dystonia as a cause [3,12,13].
Neurogenic and Myopathic Deformities of the Cervical Spine
2011, Seminars in Spine SurgeryCitation Excerpt :Many patients have an inability to hyperextend the neck. When patients attempt to extend the head voluntarily or passively, muscle contraction of the anterior neck muscles becomes prominent.24,25 Muscle biopsies and EMGs of the posterior extensor muscles have shown evidence of fibrotic changes; however, most EMGs show normal muscle function, suggesting the etiology of DHS in Parkinson's is different from in other myopathies.22,25,26