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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