Cervical spondylotic myelopathy caused by violent motor tics in a child with Tourette syndrome.
BACKGROUND
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.


METHODS
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.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
Da-Young
DY
Ko
Seung-Ki
SK
Kim
Jong-Hee
JH
Chae
Kyu-Chang
KC
Wang
Ji Hoon
JH
Phi
D002648:Child; D006801:Humans; D008297:Male; D011859:Radiography; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D055009:Spondylosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D020323:Tics / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005879:Tourette Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery