Tourettism in a 73-year-old man after coronary artery bypass surgery

Abstract

We present a patient who developed motor and vocal tics eight months alter coronary artery bypass graft surgery (CABGS). The patient demonstrated a few motor tics like picking, blowing his nose and a vocal tic in the form of shouting. He also described premonitory sensory urges. The significance of our case is the appearance of these tics for the first time after the CABGS in a 73 year-old male patient. The patient showed ischemic regions in the bilateral basal ganglia in the magnetic resonance imaging (MRI) and his single photon emission tomography (SPRCT) examination revealed hypoperfusion in the right caudate nucleus and bilateral frontotemporoparietal cortex, which are the brain regions associated with tic pathogenesis. Although reaching a definitive conclusion is difficult since we do not have preoperative cranial imaging, wc suggest that tics might have appeared as a result of a perfusion abnormality he had incurred during the CABGS.