Pisa syndromet

Abnormal postures of the trunk are a typical feature of Parkinson's disease (PD).
These include Pisa syndrome (PS), a tonic lateral flexion of the trunk associated with slight rotation along the sagittal plane.
PD patients with PS showed a significantly higher score of disease asymmetry compared with the control group.
In the majority of patients with PS, trunk bending was contralateral to the side of symptom onset.
EMG showed abnormal tonic hyperactivity on the side of the deviation in the paravertebral thoracic muscles and in the abdominal oblique muscles.
CT of the lumbar paraspinal muscles showed muscular atrophy more marked on the side of the deviation, with a craniocaudal gradient.
PS may represent a complication of advanced PD in a subgroup of patients who show more marked asymmetry of disease and who have detectable hyperactivity of the dorsal paravertebral muscles on the less affected side.
This postural abnormality deserves attention and proper early treatment to prevent comorbidities and pain.

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