Clinical Pearls - how my patients taught me: The fainting lark symptom.
BACKGROUND
Compulsive movements, complex tics and stereotypies are frequent, especially among patients with autism or psychomotor retardation. These movements can be difficult to characterize and can mimic other conditions like epileptic seizures or paroxysmal dystonia, particularly when abnormal breathing and cerebral hypoxia are induced.


METHODS
We describe an 18-year-old patient with Asperger syndrome who presented with attacks of tonic posturing of the trunk and neck. The attacks consisted of self-induced stereotypic stretching of the neck combined with a compulsive Valsalva-like maneuver. This induced cerebral hypoperfusion and subsequently dysautonomia and some involuntary movements of the arms.


CONCLUSIONS
This patient suffered from a complex tic with compulsive respiratory stereotypies. His symptoms contain aspects of a phenomenon described in early literature as 'the fainting lark'.
Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands.
A
A
Kuiper
Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands.
M E
ME
van Egmond
Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
M P M
MP
Harms
Jonx Department of Youth Mental Health, Lentis Psychiatric Institute, Groningen, The Netherlands.
M D
MD
Oosterhoff
Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
B
B
van Harten
Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
D A
DA
Sival
Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands ; Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
T J
TJ
de Koning
Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700RB Groningen, The Netherlands.
M A J
MA
Tijssen
Compulsive Valsalva; Respiratory stereotypies; Stretch syncope