Tourette syndrome producing tics involving the neck has rarely been reported to result in cervical myelopathy.^1,2 The pathophysiology of the associated spinal cord injury is poorly understood. We describe a unique case of a patient with Tourette’s presenting with severe motor tic induced myelopathy and a contrast-enhancing cervical cord lesion that improved with pharmacological management.

A 20-year-old male with Tourette syndrome, taking tiapride 100mg TID, presented with a 2-month history of progressive bilateral upper and lower limb weakness and sensory symptoms with bladder and bowel hesitancy. He displayed a repetitive complex motor tic with head turning to the right with upward shoulder thrusting. The exam was consistent with a severe myelopathy.

The patient’s MRI of the c-spine revealed a C1 level heterogeneously gadolinium-enhancing lesion. There was no evidence of spinal cord compression on routine saggital/axial views. All other extensive investigations were unremarkable. An MRI with his neck held in a special position of rotation mimicking his tic confirmed narrowing of the spinal canal at the C1-C2 level with effacement of CSF and spinal cord indentation, which was not seen on standard MRI suggesting compression from tics.  

The tiapride dose was increased to 200 mg TID, which resulted in marked improvement of motor tics. At 5 and 12 months follow-up, the patient reported a 50% reduction in his tic frequency with improvement of his motor and sensory symptoms and near resolution of his bladder and bowel hesitancy. Repeat MRI showed interval resolution of enhancement within the C1 lesion.

Contrast enhancement has been reported in cervical myelopathy associated with tics but no cases have established resolution of the contrast enhancement with the control of tics. Other cases may require alternative strategies for the management of tics in order to avoid long-term disability such as botulism toxin injections or decompression surgery.