Objective: To report a rare case of complex motor and vocal tics in a child with communicating hydrocephalus and discuss the diagnostic considerations and clinical outcome

Background: Tic disorders are common in childhood; however, their occurrence with structural brain abnormalities such as hydrocephalus is uncommon and may complicate diagnosis. Communicating hydrocephalus results from impaired cerebrospinal fluid (CSF) absorption and can manifest with diverse neurological symptoms, including movement disorders. The coexistence of tics and hydrocephalus raises questions regarding causality and potential shared mechanisms

Method: A 12-year-old boy presented with a 6-month history of recurrent eye blinking, involuntary facial movements, and intermittent vocalizations consistent with complex motor and vocal tics. Symptoms worsened over the preceding 2 months and interfered with daily activities. Neurological examination showed no focal deficits, but mild bitemporal visual field defects and optic disc swelling suggested increased intracranial pressure. Brain magnetic resonance imaging (MRI) demonstrated ventricular enlargement consistent with communicating hydrocephalus. CSF analysis was normal. Blood investigations, including serological, metabolic, and connective tissue evaluations, were unremarkable. Autoimmune screening showed positivity for glial fibrillary acidic protein antibodies. The patient underwent ventriculoperitoneal shunt placement. Postoperatively, clonidine was initiated for tic management. Followup for 3 months included clinical assessment, electroencephalography, and monitoring of shunt function

Results: Following surgical intervention and medical therapy, the patient showed marked improvement in both motor and vocal tics, with reduced frequency and severity. Follow-up neuroimaging demonstrated stable ventricular size without evidence of shunt malfunction. The patient remained clinically stable during the follow-up period. The presence of GFAP antibodies raised the possibility of an autoimmune contribution to the movement disorder

Conclusion: This case highlights the diagnostic complexity of pediatric movement disorders when structural brain abnormalities coexist. Increased intracranial pressure may exacerbate tic manifestations, while GFAP antibody positivity suggests a potential autoimmune mechanism. Early recognition and management of hydrocephalus may lead to improvement in both neurological and movement symptoms

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MDS Abstracts - https://www.mdsabstracts.org/abstract/complex-tics-in-a-child-with-communicating-hydrocephalus-a-diagnostic-challenge/