Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome.
A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetric (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Although the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic deficits remain unchanged.
Child Study Center, Yale University School of Medicine, New Haven, CT 06510.
J F
JF
Leckman
A J
AJ
de Lotbinière
K
K
Marek
C
C
Gracco
L
L
Scahill
D J
DJ
Cohen
D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology*; D005684:Gait; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity; D011183:Postoperative Complications; D013064:Speech Disorders / Q000209:etiology*; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D013788:Thalamus / Q000473:pathology / Q000601:surgery*; D005879:Tourette Syndrome / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery