Pisa syndrome due to shunt malfunction in normal pressure hydrocephalus with comorbid Parkinson’s disease

Pisa syndrome (PS) is characterized by tonic flexion of the trunk and head to one side of the body and generally occurs in patients with Parkinson’s disease (PD) taking antipsychotic drugs. Recently, only a few cases of PS caused by normal pressure hydrocephalus (NPH) have been reported. Here, we report a case of PS associated with NPH. We believe that the presentation of this rare case may provide an interesting perspective regarding the pathophysiology of PS. Future studies involving a large number of patients are warranted to clarify the mechanisms underlying PS in distinct neurological diseases such as PD, NPH, and multiple system atrophy.