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Case report
Paroxysmal head drops with ataxia-like symptoms presenting as Sandifer syndrome in a 3-year old girl
  1. Abubakar Sharif1,
  2. Lucinda Carr2,
  3. Efstratios Saliakellis3 and
  4. Himadri Chakraborty1
  1. 1Department of Paediatrics, Basildon and Thurrock University Hospital, Basildon, UK
  2. 2Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
  3. 3Department of Paediatric Gastroenterology & Neurogastroenterology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Abubakar Sharif; abubakar.sharif{at}


We present a case of Sandifer syndrome in a 3-year-old girl who initially presented with a history of recurrent paroxysmal head drops associated with ataxia-like symptoms and recurrent falls sustaining a clavicular fracture on one occasion. She was referred to and seen by the paediatric neurologist. Physical examination, electroencephalogram, MRI brain, electromyograph single fibre study and blood tests were all normal. With the history of hiccups and choking-like episodes she was referred to the speech and language therapist (SALT). SALT assessment did not reveal indications of swallowing impairment or possible aspiration. A barium swallow later showed small amount of reflux into the distal oesophagus. This prompted a trial of lansoprazole and she was referral to the gastroenterologists. Endoscopy and oesophageal manometry were essentially normal. However, the pH impedance study revealed severe gastro-oesophageal reflux disease. She continued with lansoprazole and dairy-free diet and her symptoms resolved.

  • neurogastroenterology
  • gastro-oesophageal reflux
  • movement disorders (other than Parkinsons)
  • clinical neurophysiology
  • epilepsy and seizures

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  • Contributors AS contributed to the literature search and wrote the manuscript. HC suggested the idea of writing up the case report and checked initial draft. ES and LC checked initial draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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