Elderly onset Parkinson's disease complicated by dropped head syndrome that responded favorably to therapy*

An 86-year-old man presented with a 7-year history of gait disturbance. He was admitted to hospital in April 2000, as he was experiencing difficulty eating due to progression of dropped head syndrome. Both standing and sitting, marked dropped head and kyphosis were observed. When supine, the patient was able to stretch his neck, and he could stand and walk with the aid of a walker. Rigidity and resting tremor were present predominantly in the lower limbs. Parkinson's disease was diagnosed, and L-dopa and cabergoline were administered. Parkinsonism and dropped head syndrome improved in response to treatment. Cases involving Parkinson's disease are reportedly improved by L-dopa, but exacerbated by dopamine agonists. Dropped head syndrome is thought to attributable to imbalances in the tonus of the anterior and posterior neck muscles. Dropped head in the present case may have been a complication of Parkinson's disease, since improvements occurred in response to L-dopa.