We describe two patients with
Tourette's syndrome in whom severe
motor tics involving the neck were complicated by cervical
myelopathy. The first patient, a 21-year-old man, had complex
tics consisting of violent twisting and extending movements of the neck preceded by an irresistible urge to produce the abnormal postures. Two years after onset of these
tics, paraesthesias, sensory deficits up to the level of C4, and a gait disturbance developed. Neuroimaging studies confirmed
compressive myelopathy, and the symptoms gradually improved with
botulinum toxin injections in the posterior cervical muscles. The second patient, a 42-year-old man, had violent clonic
tics consisting of thrusting head jerks. The repetitive flexion-extension neck movements had been present since the age 10 years. At age 23, he developed progressive weakness of all four extremities and bladder and sexual dysfunction. Myelography demonstrated cervical spinal canal
stenosis with retrospondylosis from C3 through C5 and a Klippel-Feil malformation. After cervical
decompression by C3-C5
laminectomies, his spinal cord symptoms improved temporarily. The
tics, however, continued, and the
neurologic deficits of cervical
myelopathy progressed again after age 34. He did not benefit from a second operation. This report draws attention to the possibility that some
tics can produce disabling
compressive myelopathy. Early diagnosis and treatment of the
movement disorder is essential in such cases.