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Dr. Chip
Dr. Chip, Doctor (non-pediatrics specialty)
Category: Paediatrics
Satisfied Customers: 36137
Experience:  Many years of outpatient experience with all age groups
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Our son presented with sudden onset Tourette's / tics and headach

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Our son presented with sudden onset Tourette's / tics and headaches. Previously perfect health bar a persistent hyaloid artery in his right eye. Top of his class at school. Happy. Sociable. Recent MRI show dark area on left side of brain, same side as an external lump is visible yet radiology report says everything is normal. I'm confused and want to know what the dark areas are.
Hi--can you tell me what you meant by an external lump? And are you saying that you can see what looks like an abnormal dark area in his brain that the radiologist didn't remark on?
Customer: replied 3 years ago.

By his left ear he has a small lump previously disregarded by the GP (and us) as a small fatty lump. The radiologist spotted it when he started scanning and asked if he could put a marker next to it. In the scans the part of the brain on the left side next to that external lump looks as though (to my untrained eye) it has been pushed by something. In any case the development is different and in a child that is creative, linguistically-able, and in every other way normal this strikes me as odd. The radiologist did not comment on this area.

Customer: replied 3 years ago.

I've just tried to reply and sent an image but I can't see it in the thread. Did you receive it?

OK Do you by chance have the actual radiology report? Yes I have the image
Customer: replied 3 years ago.

Yes I do. Hold on a tic. Sorry about all the messages. It's the first time I've used this.

No problem. Tell me more about the tics and his headaches please. And why are we using the term Tourette's?
Customer: replied 3 years ago.

Ok so the headaches started months ago. But they were more intermittent and I put them down to viruses or not drinking enough water (because they rarely do at school). The tics started last Sep (2013) but we thought it was an allergy as it was throat clearing. We now know that was the first stage of the tics. I'm using the term Tourette's because when we went to see the private doc recently he said based on the 6 month rule that's what it is. There are new vocal tics about every 6 weeks and when they were really bad Sam would sometimes repeat the last thing he heard or a word or sentence. He also has a headbanging tic which all the docs say is what's causing his headaches but I keep on telling them the headaches started BEFORE the headbanging tic. The tics, BTW, massively improved on a gluten-free, low carb, high fat diet. The improvement is ridiculous. And his tics kick off again massively within about an hour of eating something like a pizza from Sainsbury's (which we don't allow anymore!). The headaches, although better, are still around. No family history of tics or Tourette's. I have autoimmune thyroiditis. All my family has autoimmune diseases.

OK Samuel and we can continue after this if you'd like. As to the dark spot and the other abnormalities you're seeing on that one slice on the MRI, it's just an effect of that one slice and it really doesn't indicate anything abnormal as in a tumor or an intracranial bleed. I can say that because the radiologist, who could see all the slices would have remarked if this was abnomal and seen in the other slices. Tourette's, unfortunately, has no specific cause that anyone has found. There has been some work on a connection between Tourette's and a gluten allergy or celiac disease but that link hasn't been nailed down as yet
Customer: replied 3 years ago.

I'm a little concerned about people saying that everything is normal (and the radiologist not commenting) for the simple reason that EVERY member of my family has been through years of the doctors telling them there's nothing wrong and then lo and behold I was diagnosed with Hashimoto's disease (I was a right mess by the time they diagnosed that), my dad was daignosed with Lupus (but he had been really ill for a year and was in hospital with a collapsed lung by the time they diagnosed that) and my mum had suffered multiple fractures and serious problems with her neck and spine by the time they diagnosed ankylosing spondylitis. We were all tested for things and told there was nothing wrong with us until things became REALLY bad. Not to mention two friends of mine who were told they didn't have cancer when they did but had to ask for second and even third opinions before someone took them seriously. I'm just WORRIED that although this is a small part of the brain no one can tell me why it's like that and that in conjunction with the headaches and the tics and the lumps... well. As a parent wouldn't you wonder?

Customer: replied 3 years ago.

I fully understand Samuel. What I'm saying again is that although that one area does look abnormal it's just the way that one slice is taken and I'm sure all the slices taken together show that it really isn't something abnormal like a tumor. And his symptoms really don't indicate a tumor. What you need to do is talk to the radiologist and have him go through the entire scan with all it's slices so he can show you why this really isn't anything physically wrong with his brain. And people with Tourette's have normal brain MRI's. And if you look at the other slices you sent me you can see that there's a lot of difference in one side versus the other side of the brain on any one of those slices
Customer: replied 3 years ago.

Thank you for explaining all this to me as it's very helpful. Of course I understand that one side of the brain is different in appearance from the other but it still doesn't explain why exactly where the lump is on the outside of his head, on the inside his brain appears to be pushed in. Can you see on the first image I sent? And I've looked through all the other slides and nowhere are there any areas where the brain looks SO different left and right. Nowhere. All generally symmetrical in development. Just where that lump is. I'm trying to get hold of the radiologist but I don't know if he'll reply to me....

The lump on the outside from the MRI is not like a bone tumor so it must be a soft tissue tumor like a cyst or a lipoma and it can't push the skull into the brain. If you have a problem getting the radiologist, ask the GP to get hold of him. Let me know how it goes and please remember to rate my service to you Samuel.
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