Parkinsonism with Pisa Syndrome

  • Roongroj Bhidayasiri
  • Daniel Tarsy
Part of the Current Clinical Neurology book series (CCNEU)


Lateral flexion of the trunk in parkinsonism, originally described as scoliosis due to parkinsonism, refers to a lateral deviation of the spine with a corresponding tendency to lean to one side which occurs in patients with relatively advanced parkinsonism. The direction of postural deviation and concavity of the scoliosis are usually contralateral to the side of greater parkinsonian signs. “Pisa syndrome” was originally used to describe a rare form of acute or tardive dystonia associated with treatment with antipsychotic drugs. The typical clinical feature is a tonic lateral flexion of the trunk associated with mild backward rotation. The head and neck may also be involved.


Antipsychotic Drug Multiple System Atrophy Lateral Deviation Rare Form Postural Deviation 
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Supplementary material

9 Parkinsonism w. Pisa syndrome.mp4 (MP4 7,595KB)

Examination shows lateral flexion of the trunk to the right side while seated which is sustained and unchanged when the patient performs various motor tasks. She displays facial masking, severe hypokinesia during finger tapping, and perioral tremor.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Roongroj Bhidayasiri
    • 1
    • 2
  • Daniel Tarsy
    • 3
  1. 1.Chulalongkorn Center of Excellence on Parkinson’s Disease and Related DisordersChulalongkorn University HospitalBangkokThailand
  2. 2.Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of NeurologyHarvard Medical School Beth Israel Deaconess Medical CenterBostonUSA

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