1618 - When the Head Refuses to Rise: Navigating the Diagnostic and Rehabilitation Challenges of Idiopathic Dropped Head Syndrome

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

IY

Isaiah Yim, n/a

Medical Student
Virginia Tech Carilion School of Medicine
Roanoke, Virginia, United States
KH

Karam M. Hamada, MD

Physiatry Resident
Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Submitter(s)

IY

Isaiah Yim, n/a

Medical Student
Virginia Tech Carilion School of Medicine
Roanoke, Virginia, United States

Case Diagnosis: 72yo male with an abnormal presentation of dropped head syndrome

Case Description: Patient with no significant history woke up one morning unable to lift his head off his chest. Initial exam showed severely decreased neck extension with 4+/5 BUE strength and 2+ reflexes. Cervical spine imaging did not show structural abnormalities, and the patient had no risk factors or inciting events for potential neuromuscular disorders. Initial neurology evaluation was concerned for ALS due to tongue fasciculations and muscle wasting in the trapezius, scapula, and upper extremities. Second neurology opinion ruled out ALS and other neuromuscular disorders after extensive lab work and EMG/NCS that showed an irritative myopathy of paraspinal muscles of unknown etiology. The patient received standard rehabilitation including cervical collar application, paraspinal muscle strengthening, and resisted cervical extension. By the time the patient presented to inpatient rehab 8 months later after a R hip fracture, the patient had improved and was able to lift his head with residual mild muscle weakness.

Discussions: Dropped Head Syndrome (also known as Chin on Chest Syndrome) is the gradual weakening of paraspinal muscle extensors, resulting in prolonged neck flexion and hyperkyphosis. Common causes include ALS, myasthenia gravis, inflammatory myopathies, chronic inflammatory demyelinating polyneuropathy, and facioscapulohumeral muscular dystrophy. An extensive work-up pointed to an irritative myopathy of unknown etiology, and the patient improved on standard therapies. However, the patient experienced significant emotional trauma from being communicated about the possibility of having ALS. An isolated neck extensor myopathy should be included on the differential for patients with sudden Dropped Head Syndrome.

Conclusions: Dropped Head Syndrome without a clear cause may be having a growing prevalence in our communities. While the standard of treatment is the same, it is important to communicate clearly with patients, particularly given the gravity of an ALS diagnosis.