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Kim C, Choi BS, Kim HY, Lee S. Cervical Spinal Fracture Caused by Untreated Tourette Syndrome: A Case Report. Korean J Neurotrauma 2020; 16:292-298. [PMID: 33163440 PMCID: PMC7607033 DOI: 10.13004/kjnt.2020.16.e23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 11/15/2022] Open
Abstract
Cervical myelopathy can occur in Tourette syndrome patients with severe motor tics showing repetitive and violent neck movements. However, motor tics causing spinal fractures have been rarely reported. A 15-year-old girl presented at our clinic, complaining of recent development of motor weakness of all 4 extremities. She had untreated motor tics involving the neck. Computed tomography and magnetic resonance imaging findings suggested cervical spinal fractures and myelopathy. After diagnosing of Tourette syndrome, medical and psychologic therapies were started. Her motor tics were well controlled, and no complications in the patient's daily life were observed later. Cervical radiography taken at a 9-month follow-up showed bony healings of the fractured cervical spines. Uncontrolled severe motor tics may cause spinal fractures. Conservative treatments would suffice for proper control of these tics and stabilize the spine, and considered as initial treatment in patients with Tourette syndrome.
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Affiliation(s)
- Changgon Kim
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Byeong sam Choi
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hae Yu Kim
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hull M, Parnes M. Cervical Myelopathy as a Complication of Untreated Motor Tics: A Cautionary Tale. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1718696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractTic disorders are common, affecting approximately 0.5 to 1% of children and adolescents. Treatment is required only when symptoms are bothersome or impairing to the patient, so many do not require intervention. However, on occasion tics may cause significant morbidity and are referred to as “malignant.” These malignant tics have resulted in cervical myelopathy, subdural hematoma secondary to head banging, biting of lips leading to infection of oral muscles, self-inflicted eye injuries leading to blindness, skeletal fractures, compressive neuropathies, and vertebral artery dissection. We describe a case of malignant tic disorder, with accompanying video segment, resulting in cervical myelopathy and quadriparesis in a child. We also discuss aggressive management strategies for neurologists to prevent potential lifelong disability. This case emphasizes that these malignant tics must be treated with all due haste to prevent such complications.
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Affiliation(s)
- Mariam Hull
- Section of Pediatric Neurology and Developmental Neuroscience, Pediatric Movement Disorders Clinic, Blue Bird Circle Clinic for Pediatric Neurology, Texas Children's Hospital
- Baylor College of Medicine, Houston, Texas, United States
| | - Mered Parnes
- Section of Pediatric Neurology and Developmental Neuroscience, Pediatric Movement Disorders Clinic, Blue Bird Circle Clinic for Pediatric Neurology, Texas Children's Hospital
- Baylor College of Medicine, Houston, Texas, United States
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Kim J, Kim JY, Lee JM, Kang DH, Lee CH, Park IS, Lee YS. Progressive Cervical Spondylotic Myelopathy Caused by Tic Disorders in a Young Adult with Tourette Syndrome. Korean J Neurotrauma 2019; 15:199-203. [PMID: 31720277 PMCID: PMC6826097 DOI: 10.13004/kjnt.2019.15.e24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022] Open
Abstract
Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.
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Affiliation(s)
- Jonggil Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-Yoon Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chul Hee Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Sung Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Patterson AL, Choudhri AF, Igarashi M, McVicar K, Shah N, Morgan R. Severe Neurological Complications Associated With Tourette Syndrome. Pediatr Neurol 2016; 61:99-106. [PMID: 27353696 DOI: 10.1016/j.pediatrneurol.2016.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tics and Tourette syndrome are common problems evaluated by both the general pediatrician and pediatric neurologist. The common comorbidities of tics are well known, but the severe neurological complications are rare and may not be appreciated. METHODS This is a retrospective case series and literature review. RESULTS We present here four adolescents with Tourette syndrome who had severe neurological complications secondary to motor tics. We provide the history, neurological examination, and radiological findings in addition to a review of previously reported cases of vascular and cervical cord complications associated with violent motor tics. CONCLUSIONS We highlight the importance of recognizing the presenting signs of these complications early and the need to vigorously treat violent motor tics to prevent significant neurological complications.
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Affiliation(s)
- Amy L Patterson
- Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Neurology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Asim F Choudhri
- Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Neurology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Masanori Igarashi
- Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Neurology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Kathryn McVicar
- Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Neurology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Namrata Shah
- Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Neurology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Robin Morgan
- Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Neurology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee.
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Huasen B, McCreary R, Evans J, Potter G, Silverdale M. Cervical myelopathy secondary to Tourette's syndrome managed by urgent deep brain stimulation. Mov Disord 2014; 29:452-3. [PMID: 24395181 DOI: 10.1002/mds.25797] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/18/2013] [Accepted: 12/03/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bella Huasen
- Department of Neuroradiology, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust, Greater Manchester, Salford, United Kingdom
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Ko DY, Kim SK, Chae JH, Wang KC, Phi JH. Cervical spondylotic myelopathy caused by violent motor tics in a child with Tourette syndrome. Childs Nerv Syst 2013; 29:317-21. [PMID: 23053364 DOI: 10.1007/s00381-012-1939-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION We report a case of a 9-year-old boy with Tourette syndrome (TS) who developed progressive quadriparesis that was more severe in the upper extremities. CASE REPORT He had experienced frequent and violent motor tics consisting of hyperflexion and hyperextension for years. Magnetic resonance imaging (MRI) revealed a focal high-signal intensity cord lesion and adjacent cervical spondylotic changes. Initially, the patient was observed for several months because of diagnostic uncertainty; his neurological status had improved and later worsened again. Anterior cervical discectomy of C3-4 and fusion immediately followed by posterior fixation were performed. After surgery, the neck collar was applied for 6 months. His neurological signs and symptoms improved dramatically. TS with violent neck motion may cause cervical spondylotic myelopathy at an early age. CONCLUSIONS The optimal management is still unclear and attempts to control tics should be paramount. Circumferential fusion with neck bracing represents a viable treatment option.
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Affiliation(s)
- Da-Young Ko
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
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Miyashita T, Yamazaki M, Okawa A, Yoneda M, Aiba A, Koda M, Takahashi K. Multiple neck operations in a patient with severe motor tics because of Tourette's syndrome: a case report. J Med Case Rep 2012; 6:223. [PMID: 22846593 PMCID: PMC3443656 DOI: 10.1186/1752-1947-6-223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/27/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In patients with Tourette's syndrome who have severe motor tics, involuntary neck movements can enhance degenerative changes in the cervical spine, occasionally causing myelopathy. There have been a limited number of reports on surgical treatment for cervical myelopathy caused by Tourette's syndrome, and a consensus for surgical treatment has not been fully established. To the best of our knowledge, this is the first report that describes a case of cervical myelopathy in a patient with Tourette's syndrome with severe motor tics who has undergone multiple surgeries of the cervical spine. CASE PRESENTATION A 44-year-old Asian man with severe motor tics due to Tourette's syndrome presented with cervical myelopathy. Previously, he had undergone an anterior discectomy and spinal fusion with ceramics at the C3-C4 and C5-C6 levels, but required further surgery because of displacement of the ceramics. After the second operation, he developed compression myelopathy at the sandwiched (C4-C5) disc level, and had to undergo a C4-C5 anterior discectomy and spinal fusion, which was unsuccessful.As a salvage operation, we performed a C3-C7 decompression and spinal fusion from both the anterior and posterior approaches. By thorough postoperative external immobilization of his neck, our patient's spinal fusion was successful and his neurological improvements were maintained for more than 10 years. CONCLUSIONS Patients with Tourette's syndrome with cervical myelopathy are at risk of having multiple neck operations to correct their symptoms. Postoperative immobilization and the correct selection of surgical procedure are quite important for successful spinal fusion and for avoiding complications at adjacent levels in these patients.
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Affiliation(s)
- Tomohiro Miyashita
- Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
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Sfredo E, Cecchini FMDL, Raupp SF, Bossardi JB, Falavigna A. Motor tic disorder and traumatic cervical myelopathy: a case report. COLUNA/COLUMNA 2011. [DOI: 10.1590/s1808-18512011000200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The association between motor tics and cervical myelopathy is rare and not well understood. Only a few papers in the literature reported this disorder until the present date. This is a case report of a cervical myelopathy case secondary to a motor tic disorder. A 23-year-old male with a 10-year history of motor tic disorder, involving sudden forced extension of the head and cervical spine. Disturbed tactile sensation and kinetic posturing that progressed to the Lhermitte sign every time he made the movement were detected over the last six months. Magnetic resonance imaging (MRI) showed hyperintense intramedullary lesion at C2-C3, degeneration at C3-C4, and no signs of spinal cord compression. On sagittal view, functional MRI with head extension showed anterior compression with protrusion of the intervertebral disc and posterior compression of the yellow ligaments causing spinal cord stenosis. Anterior discectomy and fixation of C3-C4 were performed. There were no complications. The patient showed improvement and the motor tics were controlled by haloperidol. The patient remains symptom-free after 2 years of follow-up. Uncontrolled motor tics can compromise spinal cord function. Functional MRI can reproduce the abnormal movements and clarify the physiopathology.
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Abstract
The aim of this work was to draw attention to potentially life-threatening symptoms associated with Tourette syndrome (TS) and to explore their relationship to TS comorbidities. Medical records of all patients with TS evaluated at our Movement Disorders Clinic between July 2003 and July 2006 were reviewed. Data on patients with malignant TS, defined as >or=2 emergency room (ER) visits or >or=1 hospitalizations for TS symptoms or its associated behavioral comorbidities, were entered into a dataset and analyzed. Five illustrative cases are described. Of 333 TS patients evaluated during the 3-year period, 17 (5.1%) met the criteria for malignant TS. Hospital admission or ER visits were for tic-related injuries, self-injurious behavior (SIB), uncontrollable violence and temper, and suicidal ideation/attempts. Compared with patients with nonmalignant TS, those with malignant TS were significantly more likely to have a personal history of obsessive compulsive behavior/disorder (OCB/OCD), complex phonic tics, coprolalia, copropraxia, SIB, mood disorder, suicidal ideation, and poor response to medications. Although TS is rarely a disabling disorder, about 5% of patients referred to a specialty clinic have life-threatening symptoms. Malignant TS is associated with greater severity of motor symptoms and the presence of >or=2 behavioral comorbidities. OCD/OCB in particular may play a central role in malignant TS; obsessive compulsive qualities were associated with life-threatening tics, SIB, and suicidal ideation. Malignant TS is more refractory to medical treatment than nonmalignant TS.
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Affiliation(s)
- Min-Yuen Cynthia Cheung
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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Lin JJ, Wang HS, Wong MC, Wu CT, Lin KL. Tourette's syndrome with cervical disc herniation. Brain Dev 2007; 29:61-3. [PMID: 17188440 DOI: 10.1016/j.braindev.2006.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 05/22/2006] [Accepted: 05/27/2006] [Indexed: 10/23/2022]
Abstract
Tourette's syndrome is manifested in a broad spectrum of motor, vocal, and behavioral disturbances. Movement disorders, such as tics, may contribute to the development of cervical myelopathy owing to the effects of involuntary movements on the neck. However, the association of cervical myelopathy with motor tics of the head and neck is rare. We report here a case of a violent, repetitive neck extension due to Tourette's syndrome that developed cervical myelopathy caused by cervical disc herniation.
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Affiliation(s)
- Jainn-Jim Lin
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Abstract
Tics, patterned movements distinct from stereotypies, myoclonus, and other hyperkinetic movements, are quite common in children, particularly among those with developmental and psychiatric disorders. Thus, tics can indicate the presence of atypical neurodevelopment or broader difficulties with cognition or mood. Tics are also the cardinal feature of Tourette syndrome, a childhood-onset neurobehavioral disorder characterized by a chronic inability to suppress or an urge to perform patterned, repetitive movements. Patients with Tourette syndrome most commonly have, in addition to tics, symptoms of inattention, hyperactivity, obsessiveness, or anxiety. Achieving the most effective treatment of a child with tics is contingent on proper diagnosis of the movement disorder and thorough assessment for other problems, followed by consideration of both nonpharmacologic and pharmacologic interventions for any and all symptoms interfering with the child's function and quality of life. This review focuses primarily on the diagnosis and medical treatment of tics in children and adolescents with Tourette syndrome.
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Affiliation(s)
- Donald Gilbert
- Movement Disorders and Tourette Syndrome Clinics, Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA.
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Wong AS, Massicotte EM, Fehlings MG. Surgical Treatment of Cervical Myeloradiculopathy Associated with Movement Disorders. ACTA ACUST UNITED AC 2005; 18 Suppl:S107-14. [PMID: 15699795 DOI: 10.1097/01.bsd.0000128693.44276.86] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Movement disorders may be associated with advanced cervical myeloradiculopathy, which represents a major management challenge. We report on eight patients with movement disorders causing progressive cervical myeloradiculopathy who were treated successfully by cervical decompression and reconstruction. RESULTS The mean age of our patients was 44 years with a male/female ratio of 3:1. The average duration of symptoms prior to presentation was 10 months. The most common levels decompressed and reconstructed were C3-C4 and C4-C5. Six cases showed improvement, and two cases showed stabilization of neurologic status at a mean follow-up of 21 months. Our management strategy and results are interpreted in the context of a systematic review of the literature in which 78 cases are reported. CONCLUSIONS Movement disorders cause premature cervical spondylosis most commonly involving the C3-C4 and C4-C5 levels. Ventral pathology with kyphotic angulation requires corpectomy or discectomy with or without posterior decompression and reconstruction. Decompression should always be combined with segmental internal fixation. Perioperative use of botulinum toxin and halo vest immobilization can increase the rate of clinical success but requires vigilance to minimize complications. Laminectomy with lateral mass fixation may be used successfully in the absence of kyphotic deformity.
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Affiliation(s)
- Albert S Wong
- Division of Neurosurgery, University of Toronto, and Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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