Scientific BACKGROUND: Dropped head sing is characterized by severe neck flexion. It results from neck extensor weakness or increased tone of the flexor muscles. This sign is usually reported in neuromuscular diseases such as amyotrophic lateral sclerosis, myasthenia gravis, polymyositis and myopathy. Among extrapyramidal disorders, dropped head sign is not very common. CASE: Only one case with early dropped head and parkinsonism have been reported in our movement disorders department between 1998 and 2006 among our 330 parkinsonism patients. CONCLUSIONS: Existence of dropped head with extrapyramidal disorders makes one think of MSA. This sign has been reported in Parkinson’s disease recently. Its physiopathology, clinical features, and incidence have not been clarified yet. In our case, which is the first case among 330 patients, with levodopa treatment parkinsonism showed remarkable improvements whereas dropped head sign didn’t show any improvements