Challenges in the diagnosis and management of coexisting drop-head syndrome and dysphagia: a case report and review of the literature.
6 affiliations
- 1Department of Biomedical Sciences for Health, University "La Statale", Milan, Italy.
- 2Azienda di Servizi alla Persona Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, Milan, Italy.
- 3Medical Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Milan, Italy.
- 4Medical Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Milan, Italy. [email protected].
- 5School of Physical and Rehabilitation Medicine, University "La Statale", Milan, Italy. [email protected].
- 6Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy.
Abstract
Background
This paper presents a comprehensive diagnostic method for coexisting dropped head syndrome (DHS) and dysphagia, both associated with long-term complications of neck radiation. The symptoms reported are common after radiotherapy, but their co-occurrence, causal link, and the years since the initial treatments all contribute to the uniqueness of the case presented. A literature review on the topic is also included.Case presentation
A 54-year-old White male presented with progressive neck extensor weakness consistent with dropped head syndrome (DHS), associated with dysphagia and voice changes, occurring 17 years after radiotherapy for Hodgkin's lymphoma. A comprehensive clinical and instrumental evaluation, including a videofluoroscopic swallowing study (VFSS), electromyography (EMG), and magnetic resonance imaging (MRI), revealed mild-to-moderate dysphagia characterized by reduced swallowing efficiency, with residue in the valleculae and pyriform sinuses (> 50% occupancy) and a Penetration-Aspiration Scale score of 1 (no aspiration). The findings were consistent with postural and neuromuscular alterations involving the cervical region. Bolus clearance improved with manual head support. A structured 2-week rehabilitation program was associated with improved quality of life (as reported by improvement in the SWAL-QOL score) and stable nutritional status, though no objective physiological change was documented on the follow-up electromyographic exam. To our knowledge, this is the first work describing the importance of considering delayed-onset swallowing impairment associated with DHS in patients previously treated with radiotherapy for head-and-neck malignancies.Conclusions
The co-occurrence of DHS and dysphagia, both related to long-term complications of neck radiation, necessitates a comprehensive diagnostic approach that is currently lacking in the relevant literature. Swallowing assessments and screenings should be standard procedures in the long-term follow-up of tumors affecting the head-and-neck regions. The study underscores the importance of considering neuromuscular pathophysiological and mechanical mechanisms in post-radiotherapy dysphagia.
Related
- Near fatal asthma, challenges of management with coexisting pneumothorax.
- Application Value and Cognitive Challenges of PET/CT in the Diagnosis and Treatment of Visceral Leishmaniasis: A Retrospective Single-Center Case Series and Literature Review
- Pulmonary Epithelioid Trophoblastic Tumor Without Demonstrable Uterine Involvement: A Case Report and Literature Review Highlighting Diagnostic Challenges and Multidisciplinary Management
- Current Evidence, Diagnostic Challenges, and Contemporary Management of Lymphocytic Colitis: A Case Report and Literature Review
- Case Report: Catamenial pneumothorax: clinical characteristics, diagnosis, and management — a report of two cases with a review of the literature
BibTeX
@article{malfitano2026challenges,
title = {{Challenges in the diagnosis and management of coexisting drop-head syndrome and dysphagia: a case report and review of the literature.}},
author = {Calogero Malfitano and Denise Pighetti and Caterina Calvi and Camilla Meneguzzo and Alberto Doretti and Antonio Robecchi Majnardi},
journal = {Journal of medical case reports},
year = {2026},
month = aug,
doi = {10.1186/s13256-026-06400-5},
url = {https://europepmc.org/article/MED/42972390},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Challenges in the diagnosis and management of coexisting drop-head syndrome and dysphagia: a case report and review of the literature.
AU - Calogero Malfitano
AU - Denise Pighetti
AU - Caterina Calvi
AU - Camilla Meneguzzo
AU - Alberto Doretti
AU - Antonio Robecchi Majnardi
PY - 2026
DA - 2026/08/05
JO - Journal of medical case reports
DO - 10.1186/s13256-026-06400-5
UR - https://europepmc.org/article/MED/42972390
AB - Background This paper presents a comprehensive diagnostic method for coexisting dropped head syndrome (DHS) and dysphagia, both associated with long-term complications of neck radiation. The symptoms reported are common after radiotherapy, but their co-occurrence, causal link, and the years since the initial treatments all contribute to the uniqueness of the case presented. A literature review on the topic is also included.Case presentation A 54-year-old White male presented with progressive neck extensor weakness consistent with dropped head syndrome (DHS), associated with dysphagia and voice changes, occurring 17 years after radiotherapy for Hodgkin's lymphoma. A comprehensive clinical and instrumental evaluation, including a videofluoroscopic swallowing study (VFSS), electromyography (EMG), and magnetic resonance imaging (MRI), revealed mild-to-moderate dysphagia characterized by reduced swallowing efficiency, with residue in the valleculae and pyriform sinuses (> 50% occupancy) and a Penetration-Aspiration Scale score of 1 (no aspiration). The findings were consistent with postural and neuromuscular alterations involving the cervical region. Bolus clearance improved with manual head support. A structured 2-week rehabilitation program was associated with improved quality of life (as reported by improvement in the SWAL-QOL score) and stable nutritional status, though no objective physiological change was documented on the follow-up electromyographic exam. To our knowledge, this is the first work describing the importance of considering delayed-onset swallowing impairment associated with DHS in patients previously treated with radiotherapy for head-and-neck malignancies.Conclusions The co-occurrence of DHS and dysphagia, both related to long-term complications of neck radiation, necessitates a comprehensive diagnostic approach that is currently lacking in the relevant literature. Swallowing assessments and screenings should be standard procedures in the long-term follow-up of tumors affecting the head-and-neck regions. The study underscores the importance of considering neuromuscular pathophysiological and mechanical mechanisms in post-radiotherapy dysphagia.
SN - 1752-1947
ER -