Dropped Head Syndrome (DHS) Combined with Cervical Polyradiculopathy Following Radiotherapy

Abstract

We report a 55-year-old man with dropped head syndrome who developed neck extensor muscle weakness. After he was treated with radiotherapy (66Gy) two years ago because of non-small cell lung cancer, he exhibited progressive inability to lift his head with severe neck pain with the dropped head. The electrodiagnostic study revealed left cervical polyradiculopathy and polyneuropathy combined with cervical myelopathy, and localized myopathic change was detected on trapezius muscle biopsy. In his cervical magnetic resonance images revealed cervical spine compression fracture and multiple foraminal stenosis, so we concluded that dropped head posture was caused from radiotherapy induced myopathy of neck extensor muscle and left upper extremity pain and weakness was resulted from compression polyradiculopathy due to prolonged cervical flexion contracture. Although neuropathic pain and the neck movement limitation were treated with physical therapy, cervical orthosis, trigger point injection and medication, the improvement was limited. We suggest that the early diagnosis of dropped head syndrome (DHS) and appropriate rehabilitative management should be considered to prevent severe secondary complications such as myopathy and neuropathy.