Reversible dropped head syndrome after hemispheric striatal infarction

Area of Science:

• Neurology
• Neuroscience
• Movement Disorders

Background:

• Dropped head syndrome (DHS) is typically associated with neurodegenerative disorders like Parkinson disease and multiple system atrophy.
• It presents as an abnormal ante-fixed neck posture, impacting head support.

Observation:

• A 64-year-old man experienced sudden left-hand weakness and difficulty maintaining head posture post-stroke.
• MRI revealed acute ischemic changes in the right putamen and caudate nucleus.
• Surface EMG indicated hypertonicity in trapezius muscles and increased sternocleidomastoid activity during passive head lifting, suggesting neck muscle dystonia.

Findings:

• The patient's dropped head syndrome resolved completely within nine days of the stroke.
• Follow-up EMG showed normalization of neck muscle activity.
• This represents the first reported instance of reversible DHS following acute ischemic stroke.

Implications:

• This case highlights a novel, transient manifestation of stroke-induced movement disorders.
• Further investigation into similar cases is crucial for understanding the mechanisms of DHS and stroke-associated movement abnormalities.
• Findings may inform diagnostic and therapeutic strategies for post-stroke complications.