Grinevica Agnese, Udre Agnese, Balodis Arturs, Strumfa Ilze
Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia.
Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia.
Brain Sci. 2024 Jan 13;14(1):79. doi: 10.3390/brainsci14010079.
Chronic cough in children and adolescents can be troublesome both to the patient and the whole family. The most common causes of chronic cough in children are protracted bacterial bronchitis and bronchial asthma. However, differential diagnostic workup and treatment can become complicated when a cough of different etiology is encountered, especially in a child having a complex medical history for an unrelated pathology. A cough lacking any identified somatic cause and response to medical treatment in combination with core clinical features of tics that include suppressibility, distractibility, suggestibility, variability, and the presence of a premonitory sensation is labeled tic cough. Here we discuss a case of an adolescent who had atrophy of the corpus callosum and a history of ventriculoperitoneal shunting due to hydrocephalus caused by stenosis of the sylvian aqueduct, but now presented with a debilitating dry cough lasting for several months. After physical causes of cough were ruled out, the diagnosis of tic cough was reached, and multidisciplinary treatment ensured complete recovery. To the best of our knowledge, this is the first reported case showing coincidence of tic cough and hydrocephalus. The co-occurrence of non-syndromic corpus callosum atrophy and tic cough might hypothetically suggest a predisposing pathogenetic link via reduced signaling through cortical inhibitory neurons; further studies are needed. The importance of careful assessment of medical history, clinical picture, and features of the cough itself are emphasized in order to reach the correct diagnosis. Increased awareness of medical society is mandatory to recognize tic cough and to distinguish it from the neurologic manifestations of organic brain pathology.
儿童和青少年的慢性咳嗽对患者及其整个家庭来说都可能是个麻烦事。儿童慢性咳嗽最常见的原因是迁延性细菌性支气管炎和支气管哮喘。然而，当遇到病因不同的咳嗽时，鉴别诊断检查和治疗可能会变得复杂，尤其是对于有复杂病史且患有无关疾病的儿童。一种咳嗽在没有任何已确定的躯体病因且对药物治疗无反应，同时伴有抽动的核心临床特征（包括可抑制性、易分散性、暗示性、变异性以及存在先兆感觉）时，被称为抽动性咳嗽。在此，我们讨论一例青少年病例，该青少年患有胼胝体萎缩，并有因大脑导水管狭窄导致脑积水而行脑室腹腔分流术的病史，但现在出现了持续数月的使人衰弱的干咳。在排除咳嗽的躯体病因后，诊断为抽动性咳嗽，多学科治疗确保了完全康复。据我们所知，这是首例报道的抽动性咳嗽与脑积水同时存在的病例。非综合征性胼胝体萎缩与抽动性咳嗽的同时出现可能通过皮质抑制性神经元信号传导减少而假设性地提示一种易患的致病联系；还需要进一步研究。强调了仔细评估病史、临床表现以及咳嗽本身特征对于做出正确诊断的重要性。提高医学界的认识对于识别抽动性咳嗽并将其与器质性脑病变的神经学表现区分开来是必不可少的。
