Dropped head syndrome in severe hypotension

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 80/40 mmHg. 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.