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Tourette syndrome — SCE Neurology MCQ

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ModerateMovement DisordersTourette syndromeSCE Neurology

A 22-year-old woman presented with childhood-onset motor tics and vocalisations that wax and wane. On examination, tics were suppressible briefly and preceded by premonitory urge. Initial investigations showed: neurological examination was otherwise normal. What is the most likely underlying mechanism?

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Correct answer: B — tic generation from disinhibited motor programmes

tic generation from disinhibited motor programmes is the best answer because the vignette describes Tourette syndrome: motor and vocal tics beginning in childhood indicate Tourette syndrome. Immune-mediated inflammatory demyelination is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Raised intracranial pressure from impaired CSF dynamics and Dopamine receptor blockade are less appropriate because they would require different localisation, timing or test findings; Paradoxical embolism through a right-to-left shunt would fit a different syndrome. Clinical pearl: chorea is less suppressible and lacks premonitory urge.

Reference: NICE NG71; Movement Disorder Society consensus criteria