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Tourette syndrome is characterized by motor and vocal tics and a range of psychological disturbances. Although motor tics can be almost continuous, damage to underlying neural tissue is unusual. We present a young man with Tourette syndrome in whom we propose that violent axial tics have caused a progressive noncompressive myelopathy characterized by a highly distinctive radiologic appearance.
Case report.
A 20-year-old man was referred to our service with a 3-year history of progressive gait unsteadiness and foot deformity and a 2-year history of numbness in his feet and urinary hesitancy.
He had a history of motor and vocal tics since the age of 6. These included frequent violent axial spasms of the neck and trunk. The motor tics were refractory to medical treatment. He also had attention deficit hyperactivity disorder, obsessive-compulsive disorder symptoms, and mild learning difficulties. His only other medical history was hypothyroidism, diagnosed at the age of 12. His medication was thyroxine, baclofen, citalopram, and risperidone. His maternal uncle developed generalized seizures at the age of 6, but was controlled on anticonvulsant medication. His parents were nonconsanguineous.
Examination of the cranial nerves and upper limbs was unremarkable except for absent biceps and triceps jerks. He had an ataxic gait with a positive Romberg sign. There was bilateral pes cavus. There was …
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