Case history
Case history #1
A 7-year-old boy presents with a 4-month history of eye blinking and sniffing. He states that his nose feels 'weird', but when he blinks or sniffs, the sensation goes away. His symptoms have not improved with the use of antihistamines. He is able to control the blinking and sniffing, but only for a few seconds. He blinks and sniffs more frequently when he is tired or nervous, and less frequently when he is concentrating on a task. There is no significant medical history. He currently takes no medications and he had not been on any other medication prior to the onset of symptoms. His family history is negative for asthma, allergies, seizures, or tics. On physical examination, he has normal growth parameters and vital signs. His general physical examination and neurological examination are unremarkable, except for frequent eye blinking and sniffing that is suggestible and distractible.
Case history #2
A 10-year-old boy presents with a history of intermittent barking and head jerking for over 1 year. The head jerking has now become so frequent that it causes neck pain. He sometimes also repeats what others say. At home, his mother has noticed that he spends a long time bathing and he frequently washes his hands. These behaviours worsen with stress. His medical and family histories are unremarkable. He does not take medications. His development was normal, but he has always struggled in school and has had problems with maintaining attention. He has normal growth parameters and vital signs. His physical examination is unremarkable and his neurological examination is normal except for occasional barking noises and movements of his neck, as if to look up, accompanied by shoulder shrugging.
Other presentations
Although most commonly found in children, tic disorders may also present in adults. In many such cases, more trivial tics may have been present but unrecognised during childhood. Far less commonly, tic symptoms may first present in adulthood and require comprehensive evaluation to exclude underlying medical illness or toxicity.
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