title: Camptocormia or Pisa syndrome in multiple system atrophy.
abstract: Although a mild stooped posture is a hallmark of parkinsonism, extreme trunk forward flexion is not common. This phenomenon was described in different etiological entities and called camptocormia. Other similar presentations called Pisa syndrome and antecollis were described mainly in extrapyramidal disorders. Authors present two cases of probable multiple system atrophy (MSA) with predominant parkinsonism and Pisa syndrome (or camptocormia). Both of them were previously misdiagnosed as idiopathic Parkinson's disease (PD) and one was reported 1 year earlier. The typical clinical presentation fulfilling the diagnostic criteria for multiple system atrophy, rapid progression with lack of responsiveness to L-DOPA and apomorphine and typical MRI putaminal pathology observed in both cases allowed us to make a diagnosis. Accuracy of clinical diagnosis in multiple system atrophy is still very poor. Therefore, unusual or rare clinical presentations may support the final diagnosis. The camptocormia, Pisa syndrome and antecollis may represent the continuum of the same motor phenomenon and most of the authors refer them to unusual form of axial dystonia. According to many clinical presentations on different forms of camptocormia/Pisa syndrome authors conclude that not etiology, but the localization of specific lesion, probably within putamen is responsible for that form of dystonia. In cases of parkinsonism and severe forward flexion of trunk multiple system atrophy, diagnosis should be considered.
authors.affiliation: Department of Neurosurgery, Division of Functional Neurosurgery and Movement Disorders, Medical University, ul. Debinki 7, 80-211 Gdańsk, Poland. jaroslawek@amg.gda.pl
authors.forename: Jarosław
authors.initials: J
authors.lastname: Sławek
authors.forename: Mirosława
authors.initials: M
authors.lastname: Derejko
authors.forename: Piotr
authors.initials: P
authors.lastname: Lass
authors.forename: Mirosława
authors.initials: M
authors.lastname: Dubaniewicz
mesh_terms: D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D018450:Disease Progression; D018491:Dopamine Agonists / Q000627:therapeutic use; D004351:Drug Resistance / Q000502:physiology; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D011699:Putamen / Q000473:pathology / Q000503:physiopathology; D013121:Spinal Curvatures / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D013131:Spine / Q000473:pathology / Q000503:physiopathology; D013577:Syndrome; D017211:Treatment Failure
chemical_list: D018491:Dopamine Agonists