Letter to the Editor

Pisa Syndrome: Acute and Tardive Forms

Authors: Samir Kumar Praharaj, DPM, Manu Arora, MD, DPM


To the Editor:

A 30-year-old male, diagnosed as having paranoid schizophrenia for the previous 9 years, without any past or family history of major neurologic or psychiatric disorder, was initiated on intramuscular haloperidol 10 mg q.12 hours because of agitated behavior. On the fourth day, he developed sudden onset of tonic lateral flexion of the trunk toward the right side (tilted at 40°) with slight backward rotation, which increased while walking. He was administered IV promethazine 50 mg which led to complete resolution of the abnormal movement within 2 minutes. Subsequently, haloperidol was discontinued, and tablet olanzapine 10 mg/d along with tablet trihexyphenidyl 2 mg/d was initiated. There was no recurrence of dystonia thereafter.

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