La parakinésie brachiale oscitante

Parakinesia Brachialis Oscitans in a Patient With a First Manifestation of Multiple Sclerosis

Objectives

Parakinesia brachialis oscitans (PBO) is the involuntary movement of an otherwise paretic upper limb triggered by yawning. We describe the first case of PBO in a patient with a first manifestation of tumefactive multiple sclerosis (MS).

Methods

A 35-year-old man presented to the emergency department with a first episode of generalized seizure. Neurologic examination revealed left-sided spastic hemiparesis, predominantly affecting his upper limb. Brain MRI showed a tumefactive right hemisphere lesion consistent with demyelination. CSF did not document unmatched oligoclonal bands.

Results

Two weeks after admission and, despite being unable to voluntarily raise his left arm, the patient noticed a repeated and reproducible involuntary raise of this limb upon yawning, consistent with PBO. In the following weeks, the phenomenon diminished both in frequency and movement amplitude alongside motor recovery. An MRI performed 2 months later showed progression of the demyelinating lesion load and confirmed a diagnosis of MS.

Discussion

PBO is an example of autonomic voluntary motor dissociation and reflects the interplay between loss of cortical inhibition of the cerebellum in the setting of functional spinocerebellar pathways. Clinicians should be aware of this transient phenomenon which should not be mistaken as a chronic movement disorder or focal epileptic seizures.

On the Emergence of Tremor in Prodromal Parkinson's Disease

Clinical, neuropathological and neuroimaging research suggests that pathological changes in Parkinson's disease (PD) start many years before the emergence of motor signs. Since disease-modifying treatments are likely to be most effective when initiated early in the disease process, there has been significant interest in characterizing prodromal PD. Some people with PD describe autonomic symptoms at the time of diagnosis suggesting that autonomic dysfunction is a common feature of prodromal PD. Furthermore, subtle motor signs may be present and emerge prior to the time of diagnosis. We present a series of patients who, in the prodromal phase of PD, experienced the emergence of tremor initially only while yawning or straining at stool and discuss how early involvement of autonomic brainstem nuclei could lead to these previously unreported phenomena. The hypothalamic paraventricular nucleus (PVN) plays a central role in autonomic control including bowel/bladder function, cardiovascular homeostasis and yawning and innervates multiple brainstem nuclei involved in autonomic functions (including brainstem reticular formation, locus ceruleus, dorsal raphe nucleus and motor nucleus of the vagus). The PVN is affected in PD and evidence from related phenomena suggest that the PVN could increase tremor either by increasing downstream cholinergic activity on brainstem nuclei such as the reticular formation or by stimulating the locus ceruleus to activate the cerebellothalamocortical network via the ventrolateral nucleus of the thalamus. Aberrant cholinergic/noradrenergic transmission between these brainstem nuclei early in PD couldlead to tremor before the emergence of other parkinsonian signs, representing an early clinical clue to prodromal PD.

Yawning in neurology: a review

ABSTRACT Yawning is a stereotyped physiological behavior that can represent a sign or symptom of several conditions, such as stroke, parakinesia brachialis oscitans, parkinsonism, Parkinson’s disease and epilepsy. More rarely, it can occur in patients with intracranial hypertension, brain tumor, multiple sclerosis, migraine, Chiari malformation type I, and amyotrophic lateral sclerosis. Drug-induced yawning is an uncommon clinical condition and yawning in patients with autism or schizophrenia is very rare. The aim of this review is to describe in detail the occurrence of the phenomenon in such conditions, and its’ phenomenology and pathophysiology.

Yawning-Its anatomy, chemistry, role, and pathological considerations

Yawning is a clinical sign of the activity of various supra- and infratentorial brain regions including the putative brainstem motor pattern, hypothalamic paraventricular nucleus, probably the insula and limbic structures that are interconnected via a fiber network. This interaction can be seen in analogy to other cerebral functions arising from a network or zone such as language. Within this network, yawning fulfills its function in a stereotype, reflex-like manner; a phylogenetically old function, preserved across species barriers, with the purpose of arousal, communication, and maybe other functions including respiration. Abnormal yawning with ≥3 yawns/15min without obvious cause arises from lesions of brain areas involved in the yawning zone, its trajectories causing a disconnection syndrome, or from alteration of network activity by physical or metabolic etiologies including medication.

Concurrence of crossed cerebellar diaschisis and parakinesia brachialis oscitans in a patient with hemorrhagic stroke

Crossed cerebellar diaschisis (CCD) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to the supratentorial focal lesion. The phenomenon termed parakinesia brachialis oscitans (PBO) in which stroke patients experience involuntary stretching of the hemiplegic arm during yawning is rarely reported. The concurrence of CCD and PBO has never been described. A 52-year-old man had putaminal hemorrhage and demonstrated no significant recovery in his left hemiplegia after intensive rehabilitation, but his gait improved gradually. Two months after the stroke, the single photon emission computed tomography (SPECT) showed CCD. Four months after the stroke, the patient noticed PBO. The follow-up SPECT showed persistent CCD and the patient's arm was still plegic. The frequency and intensity of PBO have increased with time since the stroke. We speculate that the two phenomena CCD and PBO might share similar neuroanatomical pathways and be valuable for predicting clinical recovery after stroke.

Parakinesia brachialis oscitans during thrombolytic therapy

The authors describe a case report of a patient with parakinesia brachialis oscitans, which occurred during thrombolytic therapy, in a patient with left-middle cerebral artery occlusion.

Parakinesia brachialis oscitans: report of three cases

The term 'parakinesia brachialis oscitans' (PBO) was coined recently to describe cases of hemiplegia in which spontaneous yawning causes involuntary raising of the affected upper limb. The authors report three additional cases of PBO adding new phenomenological findings to the syndrome, discussing possible physiopathology of this phenomenon.

Can stroke localisation be used to map out the neural network for yawning behaviour?

What are the neuroanatomical structures involved in repetitive yawning during stroke?

Yawning: unsuspected avenue for a better understanding of arousal and interoception

Almost all the vertebrates yawn, testifying the phylogenetic old origins of this behavior. Correlatively speaking, yawning shows an ontogenical precociousness since it occurs as early as 12 weeks after conception and remains relatively unchanged throughout life. Thus, it is contended that these common characteristics and their diencephalic origin allow to model an approach from which emerges a pivotal link between yawning and REM sleep. Yawning and stretching reverse the muscular atonia of the REM-sleep and reopen the collapsed airways. Yawning appears as a powerful muscular stretch, recruiting specific control systems particularly the paraventricular nucleus of the hypothalamus, the locus coeruleus and the reticular activating system from which the vigor of this ancestral vestige, surviving throughout evolution with little variation, may increase arousal. On the other hand, the James-Lange theory proposes that afferent feedback from muscles and viscera provides the brain with a feeling that characterizes the active motivational state and arousal. On this basis and using selected supporting findings from the literature and from data provided by daily life, it is contended that yawning takes part in interoceptiveness by its capacity to increase arousal and self-awareness. Adaptative behaviors depend on interactions among the nervous system and the body by a continuous feedback between them. The body's schema is a main component of the self, and interoceptive process is essential to awareness of the body and arousal. Yawning contributes to bodily consciousness as a behavior affiliating a sensory motor act and his perception from which pleasure is derived. Yawning can be seen as a proprioceptive performance awareness which inwardly provides a pre-reflective sense of one's body and a reappraisal of the body schema. The behavioral consequences of adopting specific regulatory strategies and the neural systems involved act upon attention and cognitive changes.Thus, it is proposed that yawning is a part of interoceptiveness by its capacity to increase arousal and self-awareness.