title: An unusual presentation of Tourette's syndrome.
abstract: OBJECTIVE
  To report an unusual complex motor tic as the presenting symptom in a patient diagnosed with Tourette's syndrome.
  
  
  METHODS
  This case report was compiled via interview with a 9-year-old white female who presented to the private gynecologic practice of the senior author. Additional history was gained from the patient's mother and follow up information was obtained from written and verbal communication with neurology colleagues.
  
  
  METHODS
  Referral to neurology. Diagnosis of persistent perineal touching.
  
  
  RESULTS
  Diagnosis of Tourette's syndrome.
  
  
  CONCLUSIONS
  In young patients with nonspecific vulval symptoms, Tourette's syndrome should be considered in the differential diagnosis particularly if persistent self touching is a feature of the complaint. Referral to a physician experienced with the syndrome is important since the diagnosis is made on the basis of the clinical symptoms and signs.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Pediatric Gynecology, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Templeman
authors.forename: S P
authors.initials: SP
authors.lastname: Hertweck
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010502:Perineum; D020323:Tics; D014110:Touch; D005879:Tourette Syndrome / Q000175:diagnosis*