Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma

Stefano, Vincenzo Di; Attanasi, Carmine; Ferrante, Camilla; Muzio, Antonio Di

doi:10.1136/bcr-2018-226822

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…16–23 DHS is a devastating display of this weakness, and our patient's presentation is similar to that of other HL survivors with DHS. Specifically, DHS presents anywhere from 3 to 45 years after irradiation 16–23 and neck pain may precede DHS, 19,21,23 highlighting a potential prodrome. In addition, potentially seen are slight creatine kinase elevations 16,18,19,21–23 and cervical paraspinal muscle atrophy with edematous/fatty changes on MRI.…”

Section: Discussionsupporting

confidence: 72%

“…Specifically, DHS presents anywhere from 3 to 45 years after irradiation [16][17][18][19][20][21][22][23] and neck pain may precede DHS, 19,21,23 highlighting a potential prodrome. In addition, potentially seen are slight creatine kinase elevations 16,18,19,[21][22][23] and cervical paraspinal muscle atrophy with edematous/fatty changes on MRI. 19,21 EMG and biopsy of weakened muscles demonstrate myopathic 16,17,[19][20][21]23 and/or neurogenic 17,[19][20][21][22] changes.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, potentially seen are slight creatine kinase elevations 16,18,19,[21][22][23] and cervical paraspinal muscle atrophy with edematous/fatty changes on MRI. 19,21 EMG and biopsy of weakened muscles demonstrate myopathic 16,17,[19][20][21]23 and/or neurogenic 17,[19][20][21][22] changes. In our patient's cervical paraspinal muscles, EMG showed myopathy and biopsy revealed both myopathic and neurogenic changes.…”

Section: Discussionmentioning

confidence: 99%

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Testosterone Therapy for Dropped Head Syndrome: A Case Report

Felong

Balos

Silvestri

2022

Journal of Clinical Neuromuscular Disease

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Dropped head syndrome (DHS) is an impairment of neck extension resulting in a chin-on-chest deformity. DHS is rarely seen but a major hindrance to daily function in affected patients. DHS has been associated with movement disorders, neuromuscular disorders, and electrolyte and endocrine abnormalities. DHS has also been seen in survivors of Hodgkin lymphoma (HL) years after irradiation. HL survivors are also at risk for endocrine hypogonadism after chemotherapy. We present the case of a 58-year-old male HL survivor with dropped head and limited strength in his atrophic neck extensor muscles. Laboratory testing and imaging, nerve conduction studies, electromyography, and muscle biopsy of the neck extensors revealed myopathic and neurogenic changes. Conservative management was unsuccessful. With a desire to avoid surgical fixation, he asked his primary care physician to check his testosterone levels, which returned as low normal. Within 4 months of starting testosterone therapy, he no longer experienced dropped head.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Testosterone Therapy for Dropped Head Syndrome: A Case Report

Felong

Balos

Silvestri

2022

Journal of Clinical Neuromuscular Disease

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“…In addition to idiopathic DHS patients, rehabilitation treatment outcomes for PD, multiple system atrophy, cervical spondylosis, cervical spinal cord myositis, and post-radiotherapy patients have been reported [ 5 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. There is no consensus on the effect of various treatment programs in rehabilitation that includes physical therapy, combined physical therapy and orthoses, hybrid assistive limb (HAL), chiropractic or athletic rehabilitation-based physical therapy, and the SHAiR program [ 5 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. The SHAiR program was the only treatment in which the efficacy of treatment was evaluated by comparison, and good short-term results have also been reported [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The Short and Intensive Rehabilitation (SHAiR) Program Improves Dropped Head Syndrome Caused by Amyotrophic Lateral Sclerosis: A Case Report

et al. 2022

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Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This is the first case report describing the improvement of both dropped head (DH) and cervical pain after the short and intensive rehabilitation (SHAiR) program in an ALS patient with DHS. Case Report: After being diagnosed with ALS in June 2020, a 75-year-old man visited our hospital in October 2020 to receive treatment for DHS. At the initial visit, the patient’s DH was prominent during standing and walking. The pain intensity of the neck was 9 out of 10 on the numerical rating scale (NRS), which was indicative of severe pain. The patient was hospitalized for 2 weeks and admitted into the SHAiR program. DH began to decrease one week after undergoing the SHAiR program and improved two weeks later. Neck pain decreased from 9 to 6 on the NRS. Results: The SHAiR program is a rehabilitation program aimed at improving DH in patients with idiopathic DHS. The program was designed to improve neck extensor and flexor function and global spinal alignment, and the program may have contributed to the improvement of DH and neck pain. Currently, reports of conservative therapies for this disease are limited to the use of cervical orthosis. Although further research is needed on the safety and indications of treatment, the SHAiR program may be a viable treatment option.

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“…This condition may result from myriad neuromuscular or extrapyramidal disorders such as amyotrophic lateral sclerosis (ALS), myasthenia gravis, inflammatory myopathy, chronic inflammatory demyelinating polyneuropathy, hypothyroidism, congenital myopathy, and Parkinson's disease [1,2,7], however, may also be rare sequelae of radiotherapy usually for head and neck cancer, in particular, Hodgkin's lymphoma [1,4,6,8]. DHS more commonly develops as a late complication of radiation (up to 30 years post-radiation) [1,2,8,9]. Only a few cases have been reported with early-onset DHS after radiation (within a few weeks or months) [4,10,11].…”

Section: Introductionmentioning

confidence: 99%

Early-Onset Dropped Head Syndrome and Person-in-the-Barrel Syndrome After Radiation Therapy: Clinical, Electromyographic, and MRI Findings

Shields¹,

Iyer²,

Liang³

et al. 2022

Cureus

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Dropped head syndrome (DHS) involves severe weakness of the neck extensor muscles causing the mandible to drop to the chest wall. Isolated neck extensor weakness is a rare complication of radiotherapy. This condition may result within a few weeks or months following radiotherapy (early-onset) or several years after radiotherapy (late-onset), with the latter more commonly encountered. Person-in-the-barrel syndrome is marked by bilateral brachial diplegia, intact cranial nerves, and preserved lower extremity strength. We describe the unique clinical profile of a patient with a six-week history of significant neck and bilateral upper extremity weakness who was diagnosed three months prior to the onset of these symptoms with moderately differentiated squamous cell carcinoma within the base of the tongue (Stage III T2N1M0) and metastasis to the cervical lymph nodes. She underwent concurrent chemotherapy with three cycles of cisplatin (197 mg {100 mg/m 2 } x 197 m 2 ) and hyperfractionated external beam radiation therapy (total dose cGy 7000 cGy in 35 fractions {200 cGy per fraction}). She reported the rapid onset of neck and bilateral upper extremity weakness six weeks following cisplatin termination and four weeks after radiation termination. A cervical MRI suggested myositis of the cervical paraspinal muscles, and electrodiagnostic studies indicated an inflammatory myopathic process involving the cervical paraspinal and shoulder girdle muscles. The patient attained a complete resolution of her symptoms eight months after onset. This case illustrates the rare phenomenon of early-onset DHS and person-in-the-barrel syndrome caused by radiation-induced myositis. Prompt recognition of the symptoms associated with DHS and timely treatment offer the best prognosis for recovery.

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Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma

Cited by 8 publications

References 14 publications

Testosterone Therapy for Dropped Head Syndrome: A Case Report

Testosterone Therapy for Dropped Head Syndrome: A Case Report

The Short and Intensive Rehabilitation (SHAiR) Program Improves Dropped Head Syndrome Caused by Amyotrophic Lateral Sclerosis: A Case Report

Early-Onset Dropped Head Syndrome and Person-in-the-Barrel Syndrome After Radiation Therapy: Clinical, Electromyographic, and MRI Findings

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