A six year old girl who developed a Tourette-like syndrome following herpes encephalitis is reported from the Division of Child Neurology, Walter Reed Army Medical Center, Washington, DC and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. A three day prodrome of headaches, malaise, nausea and vomiting was followed by fever and focal motor seizures involving the left side of the face and the left arm. Lumbar puncture showed 122 WBCs (80% lymphocytes) and a protein of 31 mg/dl. A repeat lumbar puncture within 24 hours showed 750 WBCs, 43 RBCs, and protein 85 mg/dl. CT on hospital day three and subsequent MRIs showed a small hemorrhagic lesion in the right mesial temporal region and progressive edematous changes in the right temporal lobe, basal ganglia and thalamus. EEG showed focal slowing over the right temporal and frontal lobes. A presumptive diagnosis of herpes encephalitis was made and Acyclovir was given for ten days. At two weeks after discharge she developed eye blinking and sudden rapid recurrent purposeless nonrhythmic stereotyped motor movements and vocalizations. The tics were characterized by facial grimacing, head twitching, and shoulder shrugging plus eye rolling, facial contorsions, jumping, touching objects and body parts and making obscene gestures. Vocal tics included grunting, sniffing, and snorting sounds. The tics were suppressed after several weeks on Pimozide (Orap 1 mg b.i.d.). [1]

COMMENT. The authors refer to reports of acquired Tourette syndrome in adults. Tics followed withdrawal from neuroleptic medications or in association with herpes and other encephalitides, toxic and metabolic encephalopathies, strokes, cerebral tumors, trauma, multiple sclerosis, syphilis, Huntington’s, Alzheimer’s, and Creutzfeldt-Jakob diseases.