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Primary and reversible Pisa syndrome in juvenile normal pressure hydrocephalus

Published online by Cambridge University Press:  22 February 2013

Fidias E. Leon-Sarmiento ,
Gustavo Pradilla  and
Maria del Rosario Zambrano
Fidias E. Leon-Sarmiento*
Affiliation:
Smell and Taste Center, University of Pennsylvania, Philadelphia, PA, USA Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA Unit of Parkinson and Movement Disorders, Mediciencias Research Group, Unit of Aerospace Medicine, Universidad Nacional, Bogota, Colombia Human Aerospace Laboratory, Mount Sinai School of Medicine, New York, NY, USA
Gustavo Pradilla
Affiliation:
Department of Internal Medicine, UIS, Unit of Neurology, Bucaramanga, Colombia
Maria del Rosario Zambrano
Affiliation:
Neurorehabilitation Unit-NeuroSalud, “Ramon & Cajal” Panamerican Health Foundation, Bogota, Colombia
*
Dr Fidias E. Leon-Sarmiento, Smell and Taste Center, University of Pennsylvania, 5 Ravdin Pavilion 3400, Spruce Street, Philadelphia, PA 19104, USA. Tel: +13152458183; Fax: +13152458183; E-mail: feleones@gmail.com
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Abstract

Objective

To report a case of Pisa syndrome in a patient with idiopathic normal pressure hydrocephalus, who had never been exposed to psychotropic medications.

Methods

A 26-year-old, Colombian, male patient, was referred because he had cognitive abnormalities, gait disturbances and urinary incontinence. This patient also displayed pleurothotonos. Neurofunctional evaluations of sensory and motor integration at peripheral and central nervous system levels were done. Idiopathic normal pressure hydrocephalus (NPH) was diagnosed.

Results

Pisa syndrome disappeared after spinal tap drainage with further gait, balance and behavioural improvement. A brainstem-thalamocortical deregulation of the central sensory and motor programming, due to the chaotic enlargement of brain ventricles was thought to be the pathophysiological mechanism underlying this case.

Conclusion

NPH must not be longer considered as an exclusive geriatric disorder. Further, uncommon movement disorders may appear with this disorder, which should be carefully approached to avoid iatrogenic and deleterious pharmacological interventions.

Keywords

central nervous systemcerebral cortexdementiapsychiatric disorders
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 25 , Issue 1 , February 2013 , pp. 57 - 60
Copyright
Scandinavian College of Neuropsychopharmacology 2013

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