title: Pisa syndrome secondary to rivastigmine: a case report.
abstract: Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. drleelaraj@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Leelavathi
authors.forename: R
authors.initials: R
authors.lastname: Rosdinom
authors.forename: M
authors.initials: M
authors.lastname: Suguna
mesh_terms: D000368:Aged; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D003702:Delusions / Q000188:drug therapy; D003704:Dementia / Q000188:drug therapy; D000077265:Donepezil; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D008297:Male; D009069:Movement Disorders / Q000209:etiology*; D000077152:Olanzapine; D048448:Phenylcarbamates / Q000009:adverse effects*; D010880:Piperidines / Q000627:therapeutic use; D011187:Posture; D000068836:Rivastigmine; D013577:Syndrome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D001569:Benzodiazepines; D000077265:Donepezil; D000077152:Olanzapine; D000068836:Rivastigmine