Dropped Head Syndrome As the Initial Presentation of Myasthenia Gravis Leading to Myasthenic Crisis in an Elderly Patient.

Myasthenia gravis is an autoimmune disorder of the neuromuscular junction characterized by fatigable, fluctuating skeletal-muscle weakness that classically involves ocular and bulbar muscles, although atypical presentations occur. We describe an 84-year-old man who presented with recurrent falls and acute dropped head syndrome due to predominant neck extensor weakness, without ocular or limb involvement. A clinical diagnosis of myasthenia gravis was made, and during admission he deteriorated rapidly into myasthenic crisis, with bulbar dysfunction and hypercapnic respiratory failure requiring intensive care and mechanical ventilation. Single-fiber electromyography demonstrated markedly increased jitter, supporting the diagnosis; however, myasthenia gravis-specific antibodies were not tested during the acute admission. He was treated with intravenous immunoglobulin, pyridostigmine, and corticosteroids, resulting in clinical improvement and successful extubation. This case highlights dropped head syndrome as a rare initial presentation of myasthenia gravis. It emphasizes the importance of early recognition, as delayed diagnosis may lead to a life-threatening myasthenic crisis.