Pisa Syndrome in a Patient with Alzheimer's Disease and Concomitant Normal Pressure Hydrocephalus: A Case Report

ABSTRACT

Extrapyramidal symptoms are common in patients with advanced Alzheimer's disease and have various etiologies. We report a 65-year-old man with probable Alzheimer's disease (AD) who concomitantly developed Pisa syndrome, ataxic gait, postural instability and voiding difficulty. Pisa syndrome improved after the discontinuation of acetylcholinesterase inhibitor (AchEI) and antipsychotics. However his ataxic gait and voiding symptoms persisted. A ventriculo-peritoneal shunt operation eliminated the symptoms except for cognition. We report Pisa syndrome in a patient with Alzheimer's disease and concomitant normal pressure hydrocephalus.