Neurology Clerkships
Case 44  
Author: Sidney M. Gospe, Jr., MD, PhD
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A 9-year old boy has an 18-month history of involuntary movements of the face, neck and upper extremities. He has a poor attention span and over the past few months has developed compulsive hand washing.

PMH: No medical illnesses. He has normal motor and language development. He was held back and repeated first grade due to immature behavior and poor progress.

Medications: None.

Allergies: None.

Family History: Father was labeled as “hyperactive” in school and did not complete high school.

Social History: He is an only child and lives with his parents who are both unemployed.

BP 105/70   HR 75   T 36.8°C    RR 16
General: Weight, height, and head circumference are at the 50th percentiles for age. He is a well appearing child who is not dysmorphic.
Mental Status: Alert, normal speech for age. He has frequent sniffing and throat clearing.
HEENT: No discharge, tonsils and pharynx are normal. The neck is supple and there is no adenopathy.
Motor (Power/Tone/Bulk)
: Normal.
Sensory: Normal.
Reflexes: Normal.
Coordination: Normal.
Gait: Normal with no ataxia.
Abnormal Movements: Frequent episodes of eye closure and occasional shoulder shrugging.
Other Organs: No hepatosplenomegaly, rash or birthmarks.

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