Parakinesia brachialis oscitans: Report of three cases

Lima, Plínio M.G. de; Munhoz, Renato P.; Becker, Nílson; Teive, Hélio A.G.

doi:10.1016/j.parkreldis.2011.09.020

Cited by 9 publications

(10 citation statements)

References 7 publications

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“…The phenomenon of PBO described as unintentional hemiplegia-associated movement during yawing may appear during the flaccid or spastic phase and tended to disappear when neurological recovery was noted [ 2 , 8 ]. The variants of classic PBO in two case reports without paretic upper extremity were described by de Lima et al [ 9 ]. The yawning center has not been truly identified.…”

Section: Discussionmentioning

confidence: 99%

Concurrence of Crossed Cerebellar Diaschisis and Parakinesia Brachialis Oscitans in a Patient with Hemorrhagic Stroke

Chang

2013

Case Reports in Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Concurrence of Crossed Cerebellar Diaschisis and Parakinesia Brachialis Oscitans in a Patient with Hemorrhagic Stroke

Chang

2013

Case Reports in Medicine

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“…In terms of localization of the correspondent brain injury, PBO has been associated with lesions that affect the internal capsule, and basal ganglia and their connections, ranging from cerebrovascular, demyelinating, infectious, and expansive lesions. From a timing perspective, most cases are acute; however, they have been described even within 6 months of the injury …”

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confidence: 99%

“…Yawning is a stereotyped, involuntary, and repetitive movement observed in almost all vertebrates . It is believed that the paraventricular nucleus in hypothalamus plays a role in yawning, as well as medullary and pontine regions, with connections toward the frontal region and cervical spine.…”

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confidence: 99%

“…Dopamine, excitatory amino acids, or even oxytocin itself can stimulate further release of oxytocin in these various subcortical structures triggering yawning. On the other hand, opioids can inhibit the oxytocinergic activation, preventing it …”

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confidence: 99%

“…The pathophysiology of PBO is unknown, but there are at least three theories trying to explain it: (1) Subcortical structures disinhibited by the cerebral cortical damage might release the reticular brainstem formation interconnected with motor pathways, which can be activated by yawning; (2) an “emotional motor system” would be responsible for the involuntary movement of the hemiplegic limb and yawning would activate it as a consequence of an emotional state related to drowsiness, coactivating the bulbar and motor neurons in the brainstem; and (3) Walusinski et al . also propose a mechanism related to the connection between the respiratory peacemaker in pre‐Botzinger complex in ventrolateral medulla of the brainstem and the lateral reticular nucleus during yawning.…”

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Parakinesia Brachialis Oscitans: A Case Report

Farah

Barcellos

Boschetti

et al. 2015

Movement Disord Clin Pract

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A 51-year-old man was admitted to the emergency room with an 8-hour history of sudden right hemiparesis. On examination, right upper extremity strength was graded as 1 proximally, 2 distally, 3 for the lower limb, and there were also right central facial paralysis and motor aphasia. He had a previous medical history of hypertension, dyslipidemia, type 2 diabetes, obesity, and a stroke 3 years before with mild residual right hemiparesis. A head CT showed a large fronto-parieto-temporal hypodense area consistent with a left middle cerebral artery (MCA) territory stroke (Fig. 1). A Doppler ultrasound of the carotid and vertebral arteries revealed occlusion of the left internal carotid artery. Arteriography confirmed the left MCA occlusion and revealed two critical intracranial stenosis in the right internal carotid artery. Electrocardiogram showed a slow atrial fibrillation, and an echocardiogram revealed a left ventricular intracavitary thrombus. Before admission, he was on acetyl salicylic acid 100 mg daily, subcutaneous regular insulin 30 U twice-daily, losartan 50 mg daily, and simvastatin 40 mg daily.After approximately 48 hours of admission, he developed patterned involuntary movements in the right upper limb during yawning. The movements, as shown in the video segment (see Video 1), consisted of simultaneous lifting of the entire right upper limb associated with tremor. Upon cessation of yawning, the limb returned to its resting, paretic position. The movement reoccurred continuously with every yawn, and during the episodes, the level of consciousness was preserved, as it was between them. The phenomena ceased spontaneously 12 hours after they were first noticed.The patient remained with the same neurological deficits throughout admission. He underwent proximal and distal right internal carotid artery angioplasty and subsequent anticoagulation targeting the intracavitary thrombus. Unfortunately, after a 2-month hospital stay complicated by recurrent episodes of pulmonary and urinary tract sepsis, the patient died as a result of septic shock.Here, we describe the phenomenon termed parakinesia braquialis oscitans (PBO), recently proposed by Walusinski et al.1 Descriptions of PBO are quite consistent, with jaw opening during the yawn, accompanied by elevation of the paretic limb, and subsequent drop upon ending the movement. 1-3 This phenomenon typically occurs in the upper limbs and may be associated with milder concomitant movement of the lower extremity. In terms of localization of the correspondent brain injury, PBO has been associated with lesions that affect the internal capsule, and basal ganglia and their connections, ranging from cerebrovascular, demyelinating, infectious, and expansive lesions. From a timing perspective, most cases are acute; however, they have been described even within 6 months of the injury. 4Yawning is a stereotyped, involuntary, and repetitive movement observed in almost all vertebrates. 4 It is believed that the paraventricular nucleus in hypothalamus plays a role in yawning, as...

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