A case of pseudo Tourette-syndrome

Aims Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterised by chronic multiple motor and vocal tics. The few case reports of adult-onset TS are mostly related to acquired brain lesions. We report the case of an otherwise healthy man who first presented with complex neurological symptoms mimicking TS in adulthood. Methods A 40-year-old engineer was referred to the Department of Neuropsychiatry for late-onset tic disorder following a blunt head trauma sustained at work, which caused minor laceration of the forehead and transient loss of consciousness, with full recovery within 3 h. Initial investigations including MRI were normal. Results The patient reported a 6-month history of multiple motor tics and complex vocal tics, mainly in the form of coprolalia (racist comments, swear words and explicit sexual language). On neuropsychiatric examination, the patient produced continuous utterances and used swear words to comment on the examiner's ethnicity and religion. No motor tics were observed, and the inappropriate vocalisations were not accompanied by premonitory sensations, suppression attempts or apologetic attitude. Conclusions A diagnosis of “pseudo-Tourette” was formulated. In consideration of the often incorrect media portrayal of TS, it is hypothesised that the prevalence of scatological features in pseudo-Tourette might vastly exceed their prevalence (10–30%) in TS.