Tourette Syndrome: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Head and face to determine motor and vocal tics occurring in type, frequency, intensity, complexity
      • Entire body [motor tics]
  • Neurological examination[due todifferential diagnoses:
    • Huntington’s chorea (synonyms: Huntington’s chorea or Huntington’s disease; older name: St. Vitus’ dance) – genetic disorder with autosomal dominant inheritance characterized by involuntary, uncoordinated movements accompanied by flaccid muscle tone; as a result, problems with eating occur, among other symptoms; may be accompanied by tics (secondary tics) (rare)
    • Chorea minor (chorea Sydenham) – late manifestation of rheumatic fever (weeks to months) with involvement of the corpus striatum (part of the basal ganglia, which belong to the cerebrum); occurring almost exclusively in children; leads to hyperkineses (lightning-like movements), muscle hypotonia and mental changes; may be accompanied by tics (secondary tics) (rare)
    • Dissociative movement disorders – loss of ability to move or disturbance of movement patterns.
    • Dystonia – disturbance of the state of tension of the musculature, unspecified.
    • Focal epileptic seizures
    • Myoclonia – brief, involuntary twitching of single muscles/groups of muscles.
    • Neuroacanthocytoses (Huntington disease like 2, autosomal recessive chorea-acanthocytosis, McLeod syndrome); may be associated with tics (secondary tics) (rare)
    • Restless Legs Syndrome (RLS) – insensations mostly in the lower extremities and associated urge to move (motor restlessness).
    • Spasm hemifacialis – spasm of the part of the facial muscles supplied by the facial nerve.
    • Stereotypies – simple or complex action in speech and/or motor skills]
  • Psychiatric examination[due tocomorbidities (concomitant diseases):
    • Anxiety disorders
    • Attention-deficit/hyperactivity disorder (ADHD).
    • Autoaggression
    • Depression
    • Obsessive-compulsive disorder]

    [due todifferential diagnoses:

    • Hyperactivity
    • Mannerisms – bizarre-looking movement patterns that are most common in schizophrenic disorders
    • Obsessive-compulsive disorder]

    [due topossible sequelae:

    • Anxiety disorders
    • Depression
    • Social phobia
    • Decreased self-esteem]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.