Korean J Neurotrauma.  2019 Oct;15(2):199-203. 10.13004/kjnt.2019.15.e24.

Progressive Cervical Spondylotic Myelopathy Caused by Tic Disorders in a Young Adult with Tourette Syndrome

• Kim J
• Kim JY
• Lee JM
• Kang DH
• Lee CH
• Park IS
• Lee YS

• KMID: 2461128
• DOI: http://doi.org/10.13004/kjnt.2019.15.e24

Abstract

Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.

Keyword

Tic disorders; Spinal cord disease; Spondylosis; Tourette syndrome

MeSH Terms

Botulinum Toxins
Cervical Cord
Dyskinesias
Humans
Laminoplasty
Magnetic Resonance Imaging
Neck
Quadriplegia
Spinal Cord Diseases*
Spine
Spondylosis
Tic Disorders*
Tics*
Tourette Syndrome*
Upper Extremity
Young Adult*
Botulinum Toxins

Figure

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  FIGURE 1 Multiple high-signal intensity lesions at the level of C4-5-6 on a T2-weighted magnetic resonance imaging (A), iso-signal intensity lesion on a T1-weighted magnetic resonance image (B).

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  FIGURE 2 A plain radiograph of the cervical spine after laminoplasty and C2-T1 fusion: lateral view (A), anteroposterior view (B).

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  FIGURE 3 A recent plain radiograph of the cervical spine: lateral view (A), anteroposterior view (B).

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