Dropped head syndrome in severe hypotension

E Couchet; B Laborde; H Cassoudesalle; S Mathis; G Solé; D Guehl; B Glize; M de Seze

doi:10.1016/j.neurol.2024.03.012

Dropped head syndrome in severe hypotension

Rev Neurol (Paris). 2024 May 14:S0035-3787(24)00517-4. doi: 10.1016/j.neurol.2024.03.012. Online ahead of print.

Authors

E Couchet¹, B Laborde¹, H Cassoudesalle¹, S Mathis², G Solé², D Guehl³, B Glize¹, M de Seze⁴

Affiliations

¹ Service de MPR, University Hospital of Bordeaux, EA 4136, HACS Bordeaux University, Bordeaux, France.
² Neurology Department, University Hospital of Bordeaux, Bordeaux, France.
³ Service de neurophysiologie clinique, University Hospital of Bordeaux, Bordeaux, France.
⁴ Service de MPR, University Hospital of Bordeaux, EA 4136, HACS Bordeaux University, Bordeaux, France. Electronic address: mathieu.de-seze@chu-bordeaux.fr.

PMID: 38749790
DOI: 10.1016/j.neurol.2024.03.012

Abstract

Introduction: Dropped head syndrome (DHS) is characterized by a chin-on-chest deformity, correctable by passive neck extension.

Methods: Case report.

Results: A patient with a heavy nephrological history (dialyzed since 5 years) complained for twenty months about a falling head. The symptomatology was punctuated by dialysis sessions, with aggravation secondary to dialysis. Clinical and paraclinical exploration for neurological, neuromuscular or orthopedic disease was negative. Analysis of the post-dialysis blood pressure showed a slow and gradual decline. From the date the patient became symptomatic, blood pressure was below 80/40mmHg. The correction of blood pressure by increasing midodrine posology resulted in a cure of DHS.

Discussion: Considering the negativity of explorations, the cure of symptoms following the correction of arterial hypotension, the rhythmic nature of symptomatology by dialysis, and the recurrence of symptoms concomitantly with drops in blood pressure, we suggested that hypotension was the only etiology explaining this DHS.

Keywords: Cervical weakness; Complications of dialysis; Drop head syndrome; Hypotension; Polyneuropathy.