Bobble-head doll syndrome in an infant with an arachnoid cyst: a case report

Abstract

Background Bobble-head doll syndrome is a rare and unique movement disorder most commonly affecting children younger than 5 years of age. It is characterized by continuous or episodic movement at the frequency of 2–3 Hz. The exact mechanism of bobble-head doll syndrome has not been elucidated. Endoscopic ventriculocisternostomy is the optimal treatment option. In a literature review, there were less than 75 cases of bobble-head doll syndrome with suprasellar arachnoid cyst. Case presentation We report a case of a 1.5-year-old Asian-Syrian girl who presented with a history of excessive head nodding for 3 months that increased with walking, emotions, and stress; decreased during periods of concentration; and was absent during sleep. On physical examination, she was alert and normal, with no medical history. Laboratory assessment and ophthalmological examination were normal. Cranial magnetic resonance imaging demonstrated a well-defined thin-walled suprasellar arachnoid cyst measuring 3 × 5 × 7 cm that obstructed the foramina of Monro, with resulting hydrocephalus ventriculomegaly. The patient underwent endoscopic cystoventriculostomy and cystocisternostomy for the suprasellar arachnoid cyst. During the 6 months of follow-up, the head bobbing disappeared completely, and her growth was normal. Conclusion Despite the rareness of bobble-head doll syndrome, it is considered an important condition that must be investigated early to detect the cause and treated promptly to avoid potential complications.

Bobble Head Doll Syndrome

“…These movements are rhythmic, may intensify during stress, but are partially controllable by the patient and disappear during sleep [11]. At least 81 other cases have already been described before our cases [2,3,5,8,14,15,17,20] which have a particular clinical character due to the predominance of ‛‛non-non laterality movements''. Since the first description in 1966 [1], the consistency of intracerebral cystic abnormalities has been noticed but the direct causal link remains for the moment subject to controversies.…”

“…It is a complication of chronic hydrocephalus. The intracranial anomalies that are commonly observed are: noncommunicating hydrocephalus, supra sellar arachnoid cyst, septum pellucidum cyst, choroid plexus papilloma, stenosis of the mesencephale aqueduct [5,7,8,10]. We report 03 cases observed and managed at the Yalgado Ouédraogo University Hospital of Burkina Faso with review of the literature.…”

Idiopathic and structural episodic nonintentional head tremor in dogs: 100 cases (2004‐2022)

“…8,9 Episodic (nonintentional) head tremor might share some parallels with bobble-head doll syndrome (BHDS), 5 which is a rare movement disorder most commonly affecting children <5 years old, characterized by episodic forward and backward (yes-yes) or side-to-side (no-no) isolated head movement. 10 Its frequency is 2-3 Hz, it disappears with volitional activity, is absent during sleep, and its amplitude typically increases with walking or excitement and temporarily decreases or disappears when the child concentrates or is called. 11 Bobble-head doll syndrome has been associated with obstruction of ventricular communication at the level of the third ventricle and mesencephalic aqueduct, 11,12 such as in suprasellar cysts, third ventricular cysts or mesencephalic aqueductal obstruction.…”

“…Episodic (nonintentional) head tremor might share some parallels with bobble‐head doll syndrome (BHDS), 5 which is a rare movement disorder most commonly affecting children <5 years old, characterized by episodic forward and backward (yes‐yes) or side‐to‐side (no‐no) isolated head movement 10 . Its frequency is 2‐3 Hz, it disappears with volitional activity, is absent during sleep, and its amplitude typically increases with walking or excitement and temporarily decreases or disappears when the child concentrates or is called 11 .…”