This retrospective case study investigates the clinical presentation of a 53-year-old female who underwent mantle field radiotherapy roughly 26 years ago. This patient presents with diffuse muscle atrophy and weakness in the cervical musculature, as well as sensory deficits in the upper extremities. We sought to compare our patient’s symptoms with other patients who had been formally diagnosed with Dropped Head Syndrome (DHS) by reviewing the existing literature. We found that the clinical presentation under investigation was consistent with other patients who had received radiotherapy for Hodgkins’s disease and were then diagnosed with DHS. Electromyography (EMG), nerve conduction studies, and a cervical MRI were unable to identify a separate neurological cause for the symptoms, but the MRI did confirm the presence of diffuse muscle atrophy in the cervical musculature. After reviewing the existing literature and imaging results, we compared our patient’s symptoms to those that define DHS, and both the time of onset, presenting symptoms, and progressing course are consistent with a diagnosis of Dropped Head Syndrome.
References
[1]
Saha, B., Saha, S. and Chong, W.H. (2021) Middle-Aged Woman with Dropped Head Syndrome Due to Remote Exposure to Mantle Field Radiation. BMJ Case Reports, 14, e243725. https://doi.org/10.1136/bcr-2021-243725
[2]
O’Brien, A. and Gray, T. (2016) Clinical Manifestations of Late-Onset Dropped Head Syndrome Secondary to Mantle Field Radiotherapy for Hodgkin’s Disease. Journal of Anesthesia & Pain Medicine, 1, 1-4.
[3]
Aggarwal, S. and Amato, A. (2007) Radiation Induced Myopathy Following Mantle Field Radiation for Hodgkin’s Disease: A Report of 4 Cases. Neurology, 68, A242-A243.
[4]
Furby, A., Behin, A., Lefaucheur, J., Beauvais, K., Marcorelles, P., Mussini, J., et al. (2009) Late-Onset Cervicoscapular Muscle Atrophy and Weakness after Radiotherapy for Hodgkin Disease: A Case Series. Journal of Neurology, Neurosurgery & Psychiatry, 81, 101-104. https://doi.org/10.1136/jnnp.2008.167577
[5]
Rowin, J., Cheng, G., Lewis, S.L. and Meriggioli, M.N. (2006) Late Appearance of Dropped Head Syndrome after Radiotherapy for Hodgkin’s Disease. Muscle & Nerve, 34, 666-669. https://doi.org/10.1002/mus.20623
[6]
McFarlane, V.J., Clein, G.P., Cole, J., Cowley, N. and Illidge, T.M. (2002) Cervical Neuropathy Following Mantle Radiotherapy. Clinical Oncology, 14, 468-471. https://doi.org/10.1053/clon.2001.0021
[7]
Gillette, E.L., Mahler, P.A., Powers, B.E., Gillette, S.M. and Vujaskovic, Z. (1995) Late Radiation Injury to Muscle and Peripheral Nerves. International Journal of Radiation OncologyBiologyPhysics, 31, 1309-1318. https://doi.org/10.1016/0360-3016(94)00422-h
[8]
Hashimoto, K., Miyamoto, H., Ikeda, T. and Akagi, M. (2017) Radiologic Features of Dropped Head Syndrome in the Overall Sagittal Alignment of the Spine. European Spine Journal, 27, 467-474. https://doi.org/10.1007/s00586-017-5186-4
[9]
Yeoh, K. and Mikhaeel, N.G. (2011) Role of Radiotherapy in Modern Treatment of Hodgkin’s Lymphoma. Advances in Hematology, 2011, Article ID: 258797. https://doi.org/10.1155/2011/258797
[10]
van Leeuwen-Segarceanu, E., Dorresteijn, L., Pillen, S., Vogels, O. and Alfen, N.V. (2009) Progressive Muscle Atrophy and Weakness after Treatment by Mantle Field Radiotherapy in Patients with Hodgkin’s Lymphoma.
[11]
Shanbhag, S. and Ambinder, R.F. (2017) Hodgkin Lymphoma: A Review and Update on Recent Progress. CA: A Cancer Journal for Clinicians, 68, 116-132. https://doi.org/10.3322/caac.21438
[12]
Grimm, S. and Chamberlain, M. (2011) Hodgkin’s Lymphoma: A Review of Neurologic Complications. Advances in Hematology, 2011, Article ID: 624578. https://doi.org/10.1155/2011/624578
[13]
Igawa, T., Isogai, N., Suzuki, A., Kusano, S., Sasao, Y., Nishiyama, M., et al. (2020) Establishment of a Novel Rehabilitation Program for Patients with Dropped Head Syndrome: Short and Intensive Rehabilitation (Shair) Program. Journal of Clinical Neuroscience, 73, 57-61. https://doi.org/10.1016/j.jocn.2020.01.046
