Vertebral artery dissection leading to stroke caused by violent neck tics of Tourette syndrome

Abstract

Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. When tics cause impairment or pain, medical treatment is often recommended.1 We present a patient with Tourette syndrome who had treatment-refractory violent neck tics. We propose that the frequent violent neck tics caused a vertebral artery dissection leading to right pontine and bilateral cerebellar infarcts. ### Case report. An 18-year-old man with Tourette syndrome, obsessive compulsive disorder, and depression with violent neck tics was transferred to our institution after having right pontine and bilateral cerebellar infarcts. Imaging was consistent with a right vertebral artery dissection and basilar artery occlusion. Two days prior to hospital admission the patient had symptoms of dizziness plus tingling, headache, and left-sided numbness. In the emergency department, the head CT was negative, and he was discharged. Two days later, he presented again with signs consistent with a posterior circulation stroke including left hemiparesis, left facial droop, diplopia, and dysarthria. His head CT was originally interpreted as normal; however, on further examination, cerebellar infarcts were identified as well as abnormally dense basilar and right vertebral arteries (figure, A and B). Brain MRI showed evidence of right pontine and bilateral cerebellar infarcts (figure, C and D). The magnetic resonance arteriogram showed occlusions of the right vertebral and …