“Dropped head syndrome” is characterised by weakness of the extensor muscles of the neck, with or without involvement of the neck flexors, and is commonly caused by a variety of neuromuscular disorders, including myasthenia gravis, polymyositis, amyotrophic lateral sclerosis, facio–scapulo–humeral dystrophy, nemaline myopathy, carnitine deficiency, spinal muscular atrophy, and isolated neck extensor myopathy.^1,2 There are isolated reports of dropped head syndrome occurring in cervical spondylitis and ankylosing spondylitis.³ In this report, we describe the clinical and imaging findings of two patients who had dropped head syndrome as a rare neurological sign secondary to syringomyelia.

Case report 1

A 46 year old right handed man presented during May 2002 with insidious onset, gradually progressive weakness and wasting of the small muscles of the left hand since August 1998. This deficit stabilised after a period of one year. At the onset of illness, he had also developed mild difficulty in using his right hand for performing fine work but this symptom remained stable. He noticed occasional fasciculations over the arms for one year. After two years and nine months he developed rapidly progressive head drop and required assistance of …