Case report Camptocormia and dropped head syndrome as a clinic picture of myotonic myopathy Zehra Kocaaga a, * , Serpil Bal a , Yasemin Turan b , Alev Gurgan a , Figen Esmeli c a Department of Physical Medicine and Rehabilitation, Ataturk Research and Training Hospital, Izmir, Turkey b Department of Physical Medicine and Rehabilitation, Adnan Menderes University Medical School, Aydin, Turkey c Department of Neurology, Ataturk Research and Training Hospital, Izmir, Turkey Accepted 21 November 2007 Available online 16 July 2008 Abstract Dropped head syndrome is primarily based on weakness localized at neck extensors. It may result from motor neuron disease, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy and also from various neuromuscular diseases including inflammatory, dystro- phic and metabolic myopathies. Camptocormia (CC) on the other hand is an unusual condition characterized by progressive weakness of the extensor vertebral muscles and results in involuntary trunk flexion. CC may emerge as a clinical feature of many different conditions such as several myopathies and Parkinson’s disease. The association of dropped head syndrome with CC has been rarely published in the literature. However, this is the only case presenting with concomitant dropped head syndrome and CC as a clinical picture of myotonic dystrophy (MD). In this report we aimed to represent a female patient, who was diagnosed as having myotonic dystrophy, with concurrent dropped head syndrome and CC. Ó 2008 Elsevier Masson SAS. All rights reserved. Keywords: Camptocormia; Dropped head syndrome; Neck paravertebral muscles; Trunk paravertebral muscles; Myotonic dystrophy 1. Introduction Dropped head syndrome was described by Suarez and Kelly as a myopathy affecting predominantly the neck exten- sors [1]. The syndrome is characterized by marked weakness limited to the neck extensors. Motor neuron disease, myasthe- nia gravis, chronic inflammatory demyelinating polyneurop- athy and also various neuromuscular diseases including inflammatory, dystrophic and metabolic myopathies may cause dropped head syndrome [2,3]. Camptocormia (CC), as an unusual condition characterized by progressive flexion of the thoracolumbar spine, was first described by Brodie in 1818 [4]. CC is a motor phenomenon that develops depending on different etiologies. During the world wars I and II, CC was used in defining the psychological conversion reactions of the soldiers [5]. Causes other than psychological events include various musculoskeletal impair- ments, neurological deficits [6e8]. Oerlemans et al. named the clinical condition as dropped head syndrome when the extensor muscles are primarily affected whereas they used the term CC when the weakness is located at the thoracolumbar paraspinal muscles [9]. The picture of dropped head syndrome and CC is not typically observed at the supine position in contrast to an erect posture and particularly becomes prominent while walking [7,10,11]. The concurrency of CC and dropped head syndrome has been rarely reported in the literature [2,6,12]. Moreover, myo- tonic dystrophy was not previously reported as an underlying factor of these two clinical pictures in the literature. Here, we aimed to present the clinical and laboratory features of a 41 * Corresponding author. Izmir Ataturk Egitim ve Arastirma Hastanesi, II, Fi- zik Tedavi ve Rehabilitasyon Klinigi, 35280 Yesilyurt, Izmir, Turkey. Tel.: þ90 0232 244 44 44x2738; fax: þ90 0232 244 71 53. E-mail addresses: zehrakocaaga@hotmail.com, zehrakocaaga@gmail.com (Z. Kocaaga). 1297-319X/$ - see front matter Ó 2008 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.jbspin.2007.11.008 Available online at www.sciencedirect.com Joint Bone Spine 75 (2008) 730e733