Diagnostic Tests for Tourette Syndrome
Tourette Syndrome Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Tourette Syndrome:
- Brain & Neurological Disorders: Related Home Testing:
Tourette Syndrome Diagnosis: Book Excerpts
- Differential Diagnosis - Chorea
- Differential Diagnosis - Chorea
- Approach to the Diagnosis - LYMPHADENOPATHY, GENERALIZED
- Approach to the Diagnosis - WEAKNESS AND FATIGUE, GENERALIZED
- Approach to the Diagnosis - RASH, GENERAL
- History and physical examination - Myoclonus
- History and physical examination - Tics
- History and physical examination - Seizures, generalized tonic-clonic
- Diagnosis - Tic disorders
- History and physical examination - Myoclonus
- History and physical examination - Chorea [Choreiform movements]
- History and physical examination - Tics
- History and physical examination - Seizures, generalized tonic-clonic
- History - Lymphadenopathy, Generalized
- Differential Overview - Motor Weakness
- Diagnosis - Tic disorders
- History - Myoclonus
- History - Seizures, generalized tonic-clonic
- History - Chorea
- History - Myoclonus
- History - Seizures, generalized tonic-clonic
- History and physical examination - Myoclonus
- History and physical examination - Tics
- History and physical examination - Seizures, generalized tonic-clonic
- Approach to the Diagnosis - LYMPHADENOPATHY, GENERALIZED
- Approach to the Diagnosis - WEAKNESS AND FATIGUE, GENERALIZED
- Approach to the Diagnosis - RASH, GENERAL
- Tics - DIAGNOSIS - Tics
Tests and diagnosis discussion for Tourette Syndrome:
TS is diagnosed by observing
the symptoms and evaluating family history. Tics must be present for at
least one year. TS is a clinical diagnosis.
(Source: excerpt from NINDS Tourette Syndrome Information Page: NINDS)
Diagnosis of Tourette Syndrome: medical news summaries:
The following medical news items
are relevant to diagnosis of Tourette Syndrome:
Diagnostic Tests for Tourette Syndrome: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Tourette Syndrome.
Myoclonus:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is stable, evaluate his level of consciousness (LOC) and mental status. Ask about the frequency, severity, location, and circumstances of myoclonus. Has he ever had a seizure? If so, did myoclonus precede it? Is myoclonus ever precipitated by a sensory stimulus? During the physical examination, check for muscle rigidity and wasting, and test deep tendon reflexes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Tics:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by asking the parents how long the child has had the tic. How often does the child have the tic? Can they identify any precipitating or exacerbating factors? Can the patient control the tics with conscious effort? Ask about stress in the child’s life such as difficult school work. Next, carefully observe the tic. Is it a purposeful or involuntary movement? Note whether it’s localized or generalized, and describe it in detail.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Seizures, generalized tonic-clonic:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If you didn’t witness the seizure, obtain a description from the patient’s companion. Ask when the seizure started and how long it lasted. Did the patient report unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of a headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Also, ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Myoclonus:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is stable, evaluate level of consciousness and mental status. Ask about the frequency, severity, location, and circumstances of the myoclonus. Has he ever had a seizure? If so, did myoclonus precede it? Is the myoclonus ever precipitated by a sensory stimulus? During the physical examination, check for muscle rigidity and wasting, and test deep tendon reflexes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Chorea [Choreiform movements]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient and his family when they first noticed the choreiform movements. Do the movements disappear when the patient is asleep? Find out if anyone in the patient’s family exhibits the same type of movements, and ask about a family history of such diseases as Huntington’s disease. Also ask which medications the patient is taking. Obtain an occupational history, noting especially prolonged exposure to manganese or other metals. As you obtain the history, observe the patient for excessive restlessness and periodic facial grimaces that may interrupt his speech.
Perform a physical examination to evaluate the severity of the patient’s chorea. Ask him to stick out his tongue and keep it out. Typically, he’ll be unable to do this; instead, his tongue will dart in and out of his mouth. Observe the patient’s arms and legs separately for involuntary jerky movements. Ask him to extend and flex his hand as if halting traffic; the choreiform movements will be extremely evident in this position. Also, check for such related signs as athetosis, rigidity, or tremor.
To assess the patient for choreoathetotic gait, ask him to walk. He may change the position of his trunk and upper body parts with each step and jerk and tilt his head to one side. Because of superimposed involuntary movements and postures, the patient’s legs may move slowly and awkwardly. (An involuntary movement suspending his leg momentarily with each step may give a dancing quality to his gait.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tics:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the parents how long the child has had the tic and how often he experiences it. Can they identify any precipitating or exacerbating factors? Can the patient control the tics with conscious effort? Ask about stressors in the child’s life, such as difficult school work. Next, carefully observe the tic. Is it a purposeful or involuntary movement? Note whether it’s localized or generalized, and describe it in detail.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Seizures, generalized tonic-clonic:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you didn’t witness the seizure, obtain a description from the patient’s companion. Ask when the seizure started and how long it lasted. Did the patient report any unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have any other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lymphadenopathy, Generalized:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General. A comprehensive physical examination should be performed on all patients with generalized lymphadenopathy. Focus on those findings consistent with the most frequent causes of generalized lymphadenopathy. Note the patient’s temperature and weight, because fever and weight loss are frequent findings. Examine the skin, mucous membranes, abdominal organs, and joints; specifically, the presence of rash, mucocutaneous ulceration, organomegaly, and arthritis can be a guide to possible causes of the adenopathy. The presence of splenomegaly in a patient with adenopathy implies a systemic illness (e.g., infectious mononucleosis, lymphoma, leukemia, lupus, sarcoidosis, toxoplasmosis, or cat scratch disease) (Chapter 15.4). Additionally, search for other abnormal lymph nodes. Studies have shown that clinicians identified only 17% of those cases of generalized lymphadenopathy when it was present (1).
B. Nodal examination. The abnormal lymph node groups should be specifically examined.
1. Size. Lymph nodes enlarged up to 1 cm in diameter can be considered normal in size. These have a low malignancy risk and can usually be observed. Lymph nodes greater than 1.5 cm × 1.5 cm in area have been shown to have a 38% risk of cancer involvement and merit further workup (2).
2. Location. Anterior cervical, submandibular, and inguinal nodes are normally palpable. The presence of supraclavicular adenopathy is always abnormal and carries a 90% cancer risk in those aged more than 40 years. Postocciptal nodes are associated with infectious mononucleosis, scalp lesions, toxoplasmosis, and non-Hodgkin’s lymphoma. Axillary nodes are associated with upper extremity infections, breast cancer, cat scratch disease, and lymphomas. Epitrochlear nodes are associated with pyogenic infections, sarcoidosis, tularemia, and syphilis. Inguinal nodes are associated with lower extremity infections and sexually transmitted diseases.
3. Pain. The presence or absence of pain is not a reliable indicator of the cause of adenopathy. Capsular swelling from acute infections can cause pain as can necrotic hemorrhage from a malignant lymph node.
4. Consistency. Rock hard nodes are consistent with metastatic disease (2). Firm rubbery nodes are found with lymphomas. Soft nodes tend to occur with infectious causes; however, this should not be considered diagnostic.
Testing
A. Primary laboratory test. Initial laboratory testing should include a complete blood count (CBC) and a slide test for infectious mononucleosis (IM) (1). Atypical lymphocytes are suggestive of IM, cytomegalovirus, or toxoplasmosis. Neutropenia is found with viral illness, lupus, brucellosis, and bone marrow replacement. Severe anemia can be seen with malignancy and autoimmune processes. If the initial mononucleosis spot is negative, the test should be repeated at intervals of 1, 2, and 3 weeks, if atypical lymphocytes are present in the CBC.
B. Secondary testing. If the initial laboratory results are nondiagnostic, order a purified protein derivative (PPD), antinuclear antibody, hepatitis B surface antigen, HIV, rapid plasma reagin, cytomegalovirus serology, and chest X-ray (CXR) study. Although the CXR is seldom positive, it can be helpful in finding tuberculosis (TB), histoplasmosis, lymphoma, or sarcoidosis. Although a PPD will not be diagnostic of TB, it can be helpful in differentiating sarcoid from TB on a node biopsy (2).
C. Lymph node biopsy. If the aforementioned laboratory testing is nondiagnostic, then lymph node biopsy may be indicated. The largest and most pathologic node should be removed. Axillary and inguinal nodes should be avoided as they often reveal only reactive hyperplasia. Biopsy should be avoided in cases of suspected IM and drug reaction because the histologic picture is easily confused with malignant lymphoma (2). Experienced hematologists or hematopathologists should handle all specimens. The value of fine needle aspiration is controversial, with reasonable arguments both for and against (4).
Diagnostic assessment
Generalized lymphadenopathy merits evaluation beyond mere observation, as a specific systemic illness will be the likely cause. The history and examination should focus on infectious, autoimmune, granulomatous, and malignant causes. If a specific entity is suspected based on the history and physical examination, then that entity should be specifically evaluated. In the event the cause is unclear, first order a CBC and mononucleosis spot. If these are negative, then serologic testing and a CXR are warranted. Consider lymph node biopsy in those cases where the node is rock hard or larger than 1.5 cm × 1.5 cm in size (1). Biopsy should be avoided in those cases where viral causes are clinically suggested.
References
1. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician 1998;58:1313–1320.
2. Pangalis GA, Vassilalopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570–582.
3. Williamson HA. Lymphadenopathy in a family practice. J Fam Pract 1985;20:
449–452.
4. Henry P, Longo D. Enlargement of lymph nodes and spleen. Harrison’s on line 1999;61. www.harrisonsonline.com/
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Motor Weakness:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Motor weakness should be distinguished from functional weakness due to systemic disease. Patients with true motor weakness will complain of difficulty performing specific tasks or a feeling of heaviness or stiffness in their limbs. Myopathy can be distinguished by proximal weakness (climbing stairs or combing hair), symmetrical distribution, absence of paresthesias and pain, or disturbance of bowel or bladder function. Proximal muscle weakness is more prominent in myopathy, distal weakness in peripheral nerve or anterior horn cell disease. Bulbar weakness, manifest as difficulty speaking and swallowing, is consistent with anterior horn cell disease or neuromuscular junction disorders. Ocular weakness occurs with myasthenia gravis and myotonic or oculopharyngeal dystrophy.
Acute generalized weakness with an onset over hours can be caused by low levels of potassium, calcium, sodium, magnesium, or phosphate; by botulism; or by viral inflammatory myopathy. Spasticity, manifest as increased tone and sudden release (“clasp-knife”), occurs with CNS lesions. Rigidity occurs with extrapyramidal disorders. Functional overlay should be suspected in the presence of ratcheting “give-away” weakness.
Peek sign: Orbicularis oculi weakness is observed on gentle eye closure. After initial complete apposition of the lid margins, they separate within seconds and the white of the sclera peeks through. Ice test: A glove finger filled with crushed ice is placed over the more ptotic eyelid for 2 minutes. An increase in opening of 2 mm or more is a positive result. Quiver eye movements: very fast, small twitch, jerk-like movements of the eyes upon changing the direction of gaze. Unintelligible speech: after prolonged speaking.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Chorea:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a physical examination to evaluate the severity of the patient’s chorea. Ask him to stick out his tongue and keep it out. Typically, he’ll be unable to do this; instead, his tongue will dart in and out of his mouth. Observe the patient’s arms and legs separately for involuntary jerky movements. Ask him to extend and flex his hand as if halting traffic, and note the choreiform movements — they’ll be extremely evident in this position. Also, check for such related signs as athetosis, rigidity, or tremor.
To assess the patient for choreoathetotic gait, ask him to walk. He may change the positions of his trunk and upper body parts with each step and jerk and tilt his head to one side. Because of superimposed involuntary movements and postures, the patient’s legs may move slowly and awkwardly. (An involuntary movement suspending his leg momentarily with each step may give a dancing quality to his gait.)
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Myoclonus:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Check for muscle rigidity and wasting, and test deep tendon reflexes. Then complete the neurologic and musculoskeletal assessments.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Seizures, generalized tonic-clonic:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness. If you haven’t already done so, take the patient’s vital signs. Then complete your neurologic assessment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Myoclonus:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is stable, evaluate his level of consciousness (LOC) and mental status. Ask about the frequency, severity, location, and circumstances of myoclonus. Has he ever had a seizure? If so, did myoclonus precede it? Is myoclonus ever precipitated by a sensory stimulus? During the physical examination, check for muscle rigidity and wasting, and test deep tendon reflexes. Then perform a neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Tics:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the parents how long the child has had the tic. How often does it occur? Can they identify any precipitating or exacerbating factors? Can the patient control the tics with conscious effort? Ask about stress in the child's life such as difficult schoolwork. Next, carefully observe the tic. Is it a purposeful or involuntary movement? Note whether it's localized or generalized, and describe it in detail.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Seizures, generalized tonic-clonic:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you didn't witness the patient's seizure, obtain a description from his companion. Ask when the seizure started and how long it lasted. Did the patient report unusual sensations before the seizure began? Did the seizure start in one area of the body and spread, or did it affect the entire body right away? Did the patient fall on a hard surface? Did his eyes or head turn? Did he turn blue? Did he lose bladder control? Did he have other seizures before recovering?
If the patient may have sustained a head injury, observe him closely for loss of consciousness, unequal or nonreactive pupils, and focal neurologic signs. Does he complain of headache and muscle soreness? Is he increasingly difficult to arouse when you check on him at 20-minute intervals? Examine his arms, legs, and face (including tongue) for injury, residual paralysis, or limb weakness.
Next, obtain a history. Has the patient ever had generalized or focal seizures before? If so, do they occur frequently? Do other family members also have them? Is the patient receiving drug therapy? Is he compliant? Also, ask about sleep deprivation and emotional or physical stress at the time the seizure occurred.
Next, assess the patient's level of consciousness (LOC) and proceed with a complete neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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