Pisa syndrome (pleurothotonus) is a condition characterized by sustained flexion of the body with the head to one side, creating a "Leaning Tower" posture. It was first described by Ekbom et al. in 1972 (1). General incidence rates are not well established, although it appears to be more common in older patients; an 8% incidence was found in one series of newly admitted geropsychiatric patients (2). Most authors have described Pisa syndrome as a side effect of prolonged exposure to conventional neuroleptics (3). More recently, other agents, including atypical antipsychotics, cholinesterase inhibitors, antiemetics, and tricyclic antidepressants, have been implicated (4). Although treatment with anticholinergic agents has been proposed, definitive therapy remains the discontinuation of the offending agent (5). We report a case of suspected Pisa syndrome in a 65-year-old patient in a wheelchair receiving valproic acid.