In its original description, Pisa syndrome was reported as an iatrogenic
dystonia of the trunk caused by
neuroleptic drugs. However, sometimes, not dystonic lateral flexion of the trunk is described as Pisa syndrome. These observations support the possibility of a
drug-induced lateral flexion of the trunk with clinical presentation similar to Pisa syndrome, although with a different etiology and pathophysiology. Here, we describe the case of a male patient, with a previous
ischemic stroke and residual
spastic hemiparesis to the right side, who subacutely developed a dramatic lateral flexion of trunk (approximately 45° to the right) a few days after the introduction of
Baclofen (5 mg 3 times per day). After the discontinuation of
baclofen, a full recovery of the correct posture was obtained. In this respect, our case is paradigmatic: it is
drug-induced but not clearly dystonic in its manifestation.
Baclofen reduces the spasticity depressing the monosinaptic and polisinaptic reflex in the spinal cord by stimulating
Gamma-aminobutyric acid B (
GABA-B) receptors, which inhibit the release of
excitatory amino acids,
glutamate and
aspartate. We believe that the definition of Pisa syndrome for these forms, not clearly dystonic, might be not completely appropriate, but they should be defined more correctly as Pisa-like syndromes.