Teaching Video NeuroImages: Lithium-induced reversible Pisa syndrome

A 49-year-old man on chronic lithium therapy (1,500 mg/d) for bipolar disorder presented with a 2-year history of progressive left-lateral truncal flexion dystonia disappearing on lying supine (video 1 at Neurology.org), known as Pisa syndrome (PS), along with anterocollis and parkinsonism. Lithium serum level was normal (1.1 mmol/L). PS improved substantially 3 months after stopping lithium (video 2), supporting the diagnosis of lithium-induced PS (figure). PS has been reported with chronic use of a single or a combination of antipsychotics, but never with lithium monotherapy.1,2 Parkinsonism and PS may result from lithium-induced dopamine reuptake facilitation or dopamine receptor sensitivity reduction.2

Source: Neurology - May 1, 2017 Category: Neurology Authors: Kumar, N., Mendonca, D. A., Jog, M. Tags: RESIDENT AND FELLOW SECTION Source Type: research