Tourettism and dystonia after subcortical stroke.
The term "tourettism" has been used to describe Tourette syndrome (TS)-like symptoms secondary to some specific cause. Tics associated with attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or both, are commonly present in TS, but this constellation of symptoms has been rarely attributed to stroke. We describe two boys who suffered a subcortical stroke and subsequently developed hemidystonia, tics, and behavioral comorbidities. Both had right hemispheric stroke involving the basal ganglia at 8 years of age, and in both the latency from the stroke to the onset of left hemidystonia was 2 weeks. In addition to ADHD and OCD, both exhibited cranial-cervical motor tics but no phonic tics. The temporal relationship between the stroke and subsequent TS-like symptoms, as well as the absence of phonic tics and family history of TS symptoms in our patients, argues in favor of a cause and effect relationship, and the observed association provides evidence for an anatomic substrate for TS and related symptoms.
Kwak
Carolyn H
CH
Baylor College of Medicine, Parkinson's Disease Center and Movement Disorders Clinic, Houston, Texas, USA.
Jankovic
Joseph
J
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D020145:Basal Ganglia Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002421:Caudate Nucleus / Q000503:physiopathology; D002648:Child; D004292:Dominance, Cerebral / Q000502:physiology; D004421:Dystonia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011569:Psychiatric Status Rating Scales; D011699:Putamen / Q000503:physiopathology; D005879:Tourette Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology