title: Severe pain as a possible cause of dropped head syndrome that was attenuated after amputation of an ischemic lower limb.
abstract: BACKGROUND
  Dropped head syndrome (DHS) is defined as weakness of the neck extensor muscles causing a correctable chin-on-the-chest deformity. Here we report the case of a patient with severe pain from lower leg ischemia showing DHS whose symptoms were attenuated by pain relief after amputation of the severely ischemic lower leg. To our knowledge this is the first report indicating that severe pain can cause DHS.
  
  
  METHODS
  A 64-year-old Asian woman was referred to our department with a 1-month history of DHS. She also suffered from severe right foot pain because of limb ischemia. She began to complain of DHS as her gangrenous foot pain worsened. She had neck pain and difficulty with forward gaze. We found no clinical or laboratory findings of neuromuscular disorder or isolated neck extensor myopathy. We amputated her leg below the knee because of progressive foot gangrene. Her severe foot pain resolved after the surgery and her DHS was attenuated.
  
  
  CONCLUSIONS
  Severe pain can cause DHS. If a patient with DHS has severe pain in another part of the body, we recommend considering aggressive pain relief as a treatment option.
authors.affiliation: Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. makisatoshi@hotmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Maki
authors.affiliation: Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. masaokod@gmail.com.
authors.forename: Masao
authors.initials: M
authors.lastname: Koda
authors.affiliation: Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. takeo251274@yahoo.co.jp.
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
authors.affiliation: Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan. 19501114@faculty.chiba-u.jp.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan. masashiy@md.tsukuba.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
mesh_terms: D000671:Amputation, Surgical; D005260:Female; D005734:Gangrene / Q000473:pathology / Q000601:surgery*; D006257:Head; D006801:Humans; D007511:Ischemia / Q000473:pathology / Q000601:surgery*; D007866:Leg / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology* / Q000503:physiopathology; D009334:Neck Muscles / Q000503:physiopathology; D019547:Neck Pain / Q000150:complications* / Q000503:physiopathology; D013577:Syndrome