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Cervical disc herniation in the gilles de la tourette syndrome.

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It should be emphasized that mineral deposits confined
only to the walls of a few arterioles were not listed in the
diagnosis; in the majority of cases there were free globules
of ferruginous salts in the parenchyma of the involved regions.
As mentioned by the authors and by Strassman [3], mineral deposits-even if excessive-seldom, if ever, give rise
to extrapyramidal or cerebellar dysfunction; they are incidental findings on routine examinations of the brain.
Because of the relative ubiquity of the deposits in the
absence of overt neurological signs, they may certainly be
considered benign; but the term “physiological” suggested
by Koller and Klawans implies that the deposits fulfill a role
in the normal action of the basal ganglia and cerebellum.
This seems unlikely.
7221 Pyle Rd
Bethesda, M D 20034
References
1. Koller WC, Klawans HL Cerebellar calcification on comput-
erized tomography. Ann Neurol 7: 193-194, 1980
2. Neumann MA: Iron and calcium dysmetabolism in the brain. J
Neuropathol Exp Neurol 22: 148-163, 1963
3. Strassman G: Iron and calcium deposits in the brain. J
Neuropathol Exp Neurol 8:428-435, 1949
Cervical Disc Herniation
in the Gilles de la
Tourette Syndrome
Charles B. Brill, MD, William H. Hartz, MD,
and Elliott L. Mancall. M D
Chronic trauma is recognized as a cause of annulus fibrosus
degeneration and subsequent disc herniation. W e have recently observed a patient in whom repetitive neck flexion
tics of Gilles de la Tourette syndrome resulted in cervical
disc herniation with associated cervical myelopathy.
An obese 27-year-old man of Ashkenazic Jewish ancestry developed numbness of the fingers of the right hand
followed by the appearance of tingling in both legs. Numbness ascended to the nipple line during the following
weeks. He noted stiffness of gait without involvement of
bowel or bladder. There was no neck pain.
His father had chronic facial tics. Since age 5 the patient
had had frequent rapid, repetitive jerks of various parts of
his body without loss of consciousness. His head and neck
were particularly affected. Grunting vocalizations were
frequent.
General examination was normal. Frequent stereotyped,
forceful, large-amplitude, alternating flexion and extension
movements of the neck were seen, accompanied by elevation of the right shoulder. There were twitching movements of the face and repeated grunting noises; there was
no coprolalia.
Mental status and cranial nerves were normal. Gait was
moderately spastic and the patellar and Achilles reflexes
were exaggerated. There was bilateral ankle clonus with
extensor plantar response o n the right. Strength was normal. Position and vibration senses were impaired in the
feet, and pain, temperature, and light touch sensation were
decreased throughout the legs. The cervical spine exhibited
full range of motion but was tender on percussion over C6.
A cervical myelogram demonstrated an extradural defect
ventral to the cord at the C6-C7 level consistent with a
herniated nucleus pulposus. An anterior cervical discectomy documented extruded soft disc material at the C6-C7
level. Because of the patient’s involuntary movements a fusion was not performed. His postoperative course was uncomplicated. Eight weeks later, gait and sensation were
normal although hyperreflexia persisted.
Frequent and forceful neck flexions probably caused the
disc protrusion and resultant myelopathy in our patient.
Goetz and Klawans [l] recently described two patients
with Tourette syndrome who also had compressive neuroparhies. One of these patients, a 16-year-old girl, had
a C8-Tl radiculopathy. Review of the English-language
medical writings of the past decade has failed to uncover
any further cases of this association. O n the basis of the
experience described here, we suggest that this complication be looked for in patients with Tourette syndrome
and other movement disorders such as hemiballismus,
athetosis, and torticollis.
Division of Pediatric Neurology
Hahnemann Medical College
230 N Broad St
Philadelphia, PA 191 02
Reference
1. Goetz CG, Klawans HL: Gilles de la Tourette syndrome and
compressive neuropathies. Ann Neurol 8:453, 1980
Letters
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syndrome, gilles, tourettes, disco, cervical, herniation
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