Pisa Syndrome (pleurothotonus) on Physical Exam
A tonic flexion of the trunk of the body to one side greater than 10 degrees due to dystonia (sustained muscle contraction), relieved by passive mobilization or supine position.
The name comes from its resemblance to the Leaning Tower of Pisa!
Caused commonly by:
 - drugs (e.g. neuroleptics, antiemetic, anticholinesterases)
 - neurodegenerative disorders (eg Parkinson, Multiple System Atrophy)
 - can be idiopathic. 
Pathophysiology: involves dopaminergic-cholinergic imbalance or serotonergic-noradrenergic dysfunction.
Risk factors: age, female sex, & rapid increase of neuroleptics.
Treatment: anticholinergics, physical therapy with postural retraining.

Dr. Fatimah Dandan @FatimahDandan

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