¿Qué haría usted ante un paciente adulto que consulta por pérdida de fuerza a nivel cervical con la cabeza caída? / What would you do with an adult patient who consults due to head muscle weakness and has dropped head?

La cabeza caída, bien por debilidad muscular, rigidez o anquilosis no es infrecuente en el anciano. El síndrome de la cabeza caída es una entidad rara caracterizada por cifosis cervical reductible de «mentón en tórax» secundaria a la debilidad de los músculos extensores de la cabeza. La etiología de esta enfermedad es diversa se ha descrito en enfermedades neuromusculares (polimiositis, polineuropatía desmielinizante inflamatoria crónica, miastenia gravis, esclerosis lateral amiotrófica y miositis por cuerpos de inclusión) aunque también existen casos descritos en enfermedades metabólicas como hipotiroidismo e hiperparatiroidismo. La evolución sin tratamiento suele ser desfavorable. Por ello, el conocimiento de esta entidad, asociado a una buena anamnesis y exploración física nos permitirá llegar a una correcta sospecha clínica, seleccionar las pruebas complementarias adecuadas y derivar si corresponde al siguiente nivel asistencial. A propósito de un caso hemos diseñado un algoritmo de ayuda para la sospecha y el abordaje clínico

The dropped head syndrome, whether due to muscle weakness, rigidity, or ankylosis, is not uncommon in the elderly. It is characterised by a "chin-on-chest" reducible kyphosis, which is secondary to head muscle debility. It may be associated with a neuromuscular group of diseases such as polymyositis, chronic Inflammatory demyelinating polyneuropathy, myasthenia gravis, amyotrophic lateral sclerosis, and inclusion-body myositis. Some cases associated with hypothyroidism and hyperparathyroidism have also been described. Prognosis without treatment is poor. Therefore, familiarity with this condition, together with a complete anamnesis and physical examination, should lead us to the clinical suspicion and selection of the appropriate complementary tests. In this article, a case of dropped head syndrome is reported, as well as an algorithm for its diagnosis

[What would you do with an adult patient who consults due to head muscle weakness and has dropped head?] / ¿Qué haría usted ante un paciente adulto que consulta por pérdida de fuerza a nivel cervical con la cabeza caída?

The dropped head syndrome, whether due to muscle weakness, rigidity, or ankylosis, is not uncommon in the elderly. It is characterised by a "chin-on-chest" reducible kyphosis, which is secondary to head muscle debility. It may be associated with a neuromuscular group of diseases such as polymyositis, chronic Inflammatory demyelinating polyneuropathy, myasthenia gravis, amyotrophic lateral sclerosis, and inclusion-body myositis. Some cases associated with hypothyroidism and hyperparathyroidism have also been described. Prognosis without treatment is poor. Therefore, familiarity with this condition, together with a complete anamnesis and physical examination, should lead us to the clinical suspicion and selection of the appropriate complementary tests. In this article, a case of dropped head syndrome is reported, as well as an algorithm for its diagnosis.

Neochondrogenesis in repair of full-thickness articular cartilage defects using free autogenous periosteal grafts in the rabbit. A follow-up in six months.

OBJECTIVE: To analyse the repair of lesions of articular cartilage with periosteum-free implants and follow-up at 6 months. DESIGN: Thirty-six New Zealand rabbits, 4-6 weeks old, were used. Full-thickness articular cartilage defects in the medial femoral condyle were created. Spontaneous evolution occurred in 18 animals; the other 18 animals were treated with a free autogenous periosteal tibial implant fixed with Tissucol. Animals were killed in groups of six at 8, 12 and 24 weeks. Macroscopic, histologic and histochemical results were evaluated and analysed statistically using the Mann-Whitney U-test. RESULTS: The spontaneous evolution of the lesion did not lead to complete repair in any case. The periosteum-free implant provided complete repair of the lesion and statistically significant restoration of the articular surface. CONCLUSIONS: In the rabbit, this study confirms the incomplete spontaneous repair of articular cartilage and the chondrogenic potential of tibial periosteum-free implants, with long-term maintenance of the macroscopic, histologic and histochemical characteristics of neo-cartilage. This raises the possibility of its use as an alternative method in the repair of circumscribed osteochondral lesions in young patients.