[The spectrum of Tourette Syndrome and difficulties in differential diagnosis: a case report]

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by early onset motor and vocal tics. TS should be differentiated from various movement disorders. We report the case of a 21 year-old-man who was admitted to our clinic due to treatment resistant cervical dystonia attributed to neuroleptics. During the last five years he had been treated for depressed mood, somatic delusions and aggressive behaviour. He had been given SSRIs and atypical antipsychotics at low doses; six months prior to his admission he had been switched to risperidone. Clinical examination revealed torticollis, motor stereotypies, vocal tics (sniffing, repetition of words), mental koprolalia and obsessive-compulsive symptoms. He complained of repetitive intrusive thoughts of harming his sister and thoughts of a "delusional" nature regarding somatic complaints. The patient was diagnosed as TS and was successfully treated accordingly. The presented case illustrates that TS can mimic other movement disorders. Whether patients with TS are at higher risk of developing dystonia, or tics and dystonia share a common pathophysiological mechanism (dopamine-inhibiting processes are probably involved in both conditions) is still debatable.