title: [Dropped Head Syndrome after whiplash injury in a patient treated for a Hodgkin's lymphoma by mantle field radiotherapy].
abstract: The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.
authors.affiliation: Service d'oncologie radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France. michel.schlienger@tnn.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Schlienger
authors.forename: J-P
authors.initials: JP
authors.lastname: Ferroir
authors.forename: F
authors.initials: F
authors.lastname: Huguet
authors.forename: F
authors.initials: F
authors.lastname: Deluen
authors.forename: F
authors.initials: F
authors.lastname: Pène
authors.forename: R
authors.initials: R
authors.lastname: Marseguerra
authors.forename: E
authors.initials: E
authors.lastname: Touboul
mesh_terms: D000063:Accidents, Traffic; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002572:Cervical Plexus / Q000293:injuries / Q000503:physiopathology / Q000528:radiation effects*; D002574:Cervical Vertebrae; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D004576:Electromyography; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology* / Q000503:physiopathology; D009334:Neck Muscles / Q000294:innervation* / Q000503:physiopathology; D010003:Osteoarthritis / Q000150:complications; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011832:Radiation Injuries / Q000209:etiology* / Q000503:physiopathology; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects*; D012074:Remission Induction; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage; D014911:Whiplash Injuries / Q000150:complications*
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone