Tik Benzeri Belirtilerle Başvuran Bir Çocuğun Nörolojik Değerlendirmesi: Olgu Sunumu

Öz

Bu olgu sunumu, tik benzeri semptomlarla başvuran çocuklarda nörolojik etiyolojilerin dışlanmasının ve multidisipliner bir yaklaşım benimsenmesinin önemini vurgulamaktadır. Sunumda, başlangıçta tik bozukluğu ön tanısıyla çocuk ve ergen psikiyatrisi polikliniğine yönlendirilen, ancak altta yatan nörolojik bir durumdan şüphelenilmesi üzerine pediatrik nörolojiye sevk edilen yedi yaşındaki erkek bir hastanın klinik ve tanısal süreci anlatılmaktadır. Hastada sağ gözde ve sağ elde aralıklı, istemsiz kas seyirmeleri gözlenmiştir. Elektroensefalografi (EEG) incelemesinde sağ frontotemporal bölgede keskin dalga aktivitesi saptanmış, beyin manyetik rezonans görüntülemesinde ise sol frontoparyetal bölgede nonspesifik T2/FLAIR hiperintensitesi izlenmiştir. Beyin omurilik sıvısı (BOS) analizi ve enfeksiyon panelleri normal olarak değerlendirilmiştir. Hastada intravenöz immünoglobulin (IVIG) ve pulse kortikosteroid tedavisi sonrası klinik düzelme gözlenmiştir. Bu olgu, tik benzeri semptomların her zaman primer tik bozukluklarına işaret etmeyebileceğini ve epileptik aktivite, fokal kortikal displazi gibi yapısal beyin anormallikleri ile postinflamatuar nörolojik süreçler dahil olmak üzere alternatif etiyolojiler açısından ayrıntılı bir değerlendirme yapılması gerektiğini ortaya koymaktadır.

Anahtar Kelimeler

• Tik
• Epilepsi
• Çocuk
• Fokal Kortikal Displazi
• IVIG
• EEG

Neurological Evaluation in a Child Presenting with Tic-like Symptoms: A Case Report

Öz

This case report highlights the importance of excluding neurological etiologies and employing a multidisciplinary approach in children presenting with tic-like symptoms. It describes the clinical and diagnostic process of a seven-year-old male initially referred to the child psychiatry clinic with a presumptive diagnosis of tic disorder, who was later redirected to pediatric neurology due to concerns about an underlying neurological condition. The patient exhibited intermittent, involuntary muscle twitches in the right eye and right hand. Electroencephalography (EEG) revealed sharp wave activity in the right frontotemporal region, while brain magnetic resonance imaging (MRI) demonstrated a nonspecific T2/FLAIR hyperintensity in the left frontoparietal area. Cerebrospinal fluid (CSF) analysis and infection panels were unremarkable. Clinical improvement was observed following treatment with intravenous immunoglobulin (IVIG) and pulse corticosteroids. This case underscores that tic-like symptoms are not always indicative of primary tic disorders and should prompt thorough evaluation for alternative etiologies, including epileptic activity, structural brain abnormalities such as focal cortical dysplasia, and post-inflammatory neurological processes..

Anahtar Kelimeler

• Tic
• epilepsy
• child
• focal cortical dysplasia
• IVIG
• EEG

Kaynakça

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