- •Adult-onset tics are rare, occurring either de novo or with previously unrecognised childhood tics.
- •Head trauma is an infrequent precipitant of tics, which vary in their temporal course and outcome.
- •We present a patient who developed late-onset tics after a strikingly focal brain injury.
- •A review of all previously reported post-traumatic tics is provided.
- •We discuss tics secondary to focal brain lesions, and their possible anatomical substrates.
Adult-onset tics represent either a secondary tic disorder (“tourettism”) or a late presentation of childhood tics, which may have been previously unrecognised. Head trauma has been recognised as an infrequent cause of adult-onset tic disorder, which exhibits variable temporal relationship to the inciting injury and response to therapy. We present a patient who presented with late-onset tics seven years after a circumscribed brain injury, responding well to antidopaminergic treatment. A review of all the previously reported cases of post-traumatic tic disorder is provided. Our patient is unusual in that the injury presumed to be responsible for the development of tics was of a very focal nature, akin to previously described tic disorder following vascular insults. We discuss the rare occurrence of tourettism after such focal brain lesions and analyse the insights this provides into the anatomical substrates underlying tic disorders.
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Published online: March 13, 2020
Accepted: March 8, 2020
Received: December 13, 2019
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