Two cases of dropped head syndrome following radiation therapy for neck cancer

Abstract

Dropped head syndrome (DHS) is a disabling condition that may occur as a delayed complication of radiation therapy. We report two cases of DHS that developed several years after treatment for neck malignancies. Case 1 involved a 69–year–old woman who developed DHS at the age of 66 years, five years after receiving chemoradiotherapy for nasopharyngeal carcinoma with right cervical lymph node metastasis. She presented with neck extensor muscle weakness and atrophy localized to the irradiated area, and needle electromyography revealed mixed myogenic and neurogenic changes. Case 2 involved a 77–year–old man who developed DHS at the age of 76 years, 10 years after radiation therapy for primary thyroid malignant lymphoma. His symptoms were also confined to the radiation field. In both cases, the diagnosis was consistent with delayed radiation syndrome. As cancer treatment outcomes improve and long–term survival increases, the incidence of radiation–induced DHS may rise. Awareness of this condition and its differential diagnoses is important for early recognition and appropriate management.