Hyperbaric oxygen therapy for late onset dropped head syndrome following mantle field radiation therapy for Hodgkin lymphoma: a case report and literature review

The authors present the first documented case of the apparent effective use of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced dropped head syndrome (DHS). DHS is a condition associated with progressive and often severe weakness of cervical paraspinal muscles, especially the neck extensors. This results in loss of horizontal gaze and in advanced cases causes a chin-on-chest deformity. Radiation-induced DHS is a rare, primarily late-term complication first described in patients treated with mantle field radiotherapy for Hodgkin lymphoma, though there is an increasing body of literature demonstrating a wide range of presentations. A 59-year-old man with a history of stage 2A Hodgkin lymphoma 34 years prior had been treated with extended field radiotherapy, including mantle radiotherapy, totalling 40 Gy in 19 fractions. He presented with three years of progressive neck extension weakness with associated stiffness and intermittent dysphagia. The patient underwent 60 sessions of HBOT, in conjunction with physiotherapy and thiamine replacement and demonstrated improvement of his postural maintenance and dysphagia. His improved function was maintained at three years follow-up. We discuss the literature on the management of this rare condition, including the rationale for using HBOT which is well documented for the treatment of other late-term radiotherapy side effects. This case adds to the increasing literature on the management of DHS and describes a novel approach to the management of this often-debilitating condition.