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Rare bobblehead doll syndrome reported in Syrian baby

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An 18-month-old girl who began to display “excessive head nodding” was suffering an extremely rare neurological disorder known as “bobblehead doll syndrome”, doctors found.

The toddler was brought to Tishreen University Hospital in Syria after three months of gradual onset of symptoms, characterised by excessive side-to-side head movement.

“Movements increased with walking, emotions, and stress … decreased during periods of concentration … and were absent during sleep,” her treating doctors wrote for the Journal of Medical Case Reports.

“There were no other complaints or headaches. There was no other significant history. On physical examination, the child was alert, with normal cognitive function.”

Scans of her brain revealed a large arachnoid cyst — a fluid-filled sac, often present at birth, that can put pressure on the brain causing a wide range of symptoms.

“Based on the cranial MRI and symptoms, a diagnosis of a suprasellar arachnoid cyst with BHDS was made,” the doctors wrote.

“The association between BHDS and suprasellar arachnoid cysts is extremely rare, but has been described in the medical literature.”

Bobble-head doll syndrome is a rare and unique movement disorder, typically affecting children under five and commonly linked to cysts.

The first clinical case was described in 1966 and there have been fewer than 75 reported since.

BHDS is “characterised by continuous or episodic forward and backward head nodding (yes–yes), or sometimes a side-to-side movement (no–no), at the frequency of 2–3 Hz”.

Doctors drilled a small hole in the girl’s skull and used an endoscope to drain the fluid from the cyst. She later made a full recovery.

“At follow-up six weeks after the procedure, she had a reduction in both the frequency and intensity of head movements,” they wrote. “During the six months of follow-up, the head bobbing disappeared completely, and her growth was normal.”

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