Head nodding-differential diagnostic main sign

The video documented 4 differential diagnosis of head nodding. Joubert- Boltshauser syndrome: The nodding looks like a head tremor. In addition, a recessive ataxia with muscle hypotonus, mental retardation, and eye moving disorder were found. Main diagnostic steps were: neurological examination, cranial MRI (vermis aplasia and molar tooth sign), kidney, liver, and ophthalmological tests.

The age of manifestation of Spasmus nutans is 6 to 18 months. The nodding frequency was 2 to 3 times/s, stopping at optical fixation. Dual or single high frequency nystagmus. The main diagnostic step was ophthalmological examination. Prognosis: remission within 2 to 4 years.

The age of manifestation of Bobble head doll syndrome is 7 weeks to 5 month. Slow nodding movement frequency was 2 to 3 times/s, decreasing during arbitrarily head movements and concentration. Moreover tremor, mental retardation, and visual impairment were observed.

Main diagnostic steps include cranial MRI, basal subarachnoidal cyst or cystic malformation in 3 ventricles with slowly raising brain pressure. Early neurosurgery intervention is required.

The age of manifestation of Jactatio capitis is less than 3years. Transitory stereotype rhythmical movements, sometimes joined by body rocking and aggravated by emotions, often occur before falling asleep. Main diagnostic step included behavioral observation and developmental examination. Spontaneous remission until the age of 5 years or later in presence of mental retardation later.

Conclusion: Intentional head nodding can be assigned after medical history, behavioral observation and developmental and neurological examination to a diagnostic suspicion.

The frequency and direction of movements, the circumstances under which the nodding is getting severe or stops and additional symptoms have to be considered.