Tic Cough in an Adolescent with Organic Brain Pathology— A Case Report and Literature Review

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