2005 Walusinski PBO PBO PBO PBO. [DOI] /j.issn

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1 Med J Chin PLA, Vol. 43, No. 3, March 1, [ ] (PBO) 4 PBO PBO PBO 4h~4 ( d) 1 ~3 ( ) PBO PBO PBO PBO [ ] [ ] R743.3 [ ] A [ ] (2018) [DOI] /j.issn Clinical and radiological characteristics of hemiplegic arm raising related to yawning in stroke patient LI Jian-yong 1, WU Lei 2*, CUI Fang 1,2, SUN Liu-qing 1, XIONG Jian-mei 1 1 Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan , China 2 Department of Neurology, Chinese PLA General Hospital, Beijing , China * Corresponding author, wlyingsh@163.com [Abstract] Objective To investigate the clinical and radiological characteristics of parakinesia brachialis oscitans (PBD) related to yawning in stroke patient and its mechanism. Methods We reported 4 patients with involuntary raising of the paralyzed limbs when yawning in neurological unit of Hainan Branch of Chinese PLA General Hospital, and analyzed their clinical characteristics together with published cases in literatures. Results In this group of stroke patients, when they yawned, their paralyzed upper limb could lift upward involuntarily. Totally 22 patients with ischemic (n=20) and hemorrhagic (n=2) stroke were enrolled. Brain imaging showed infarcts in the middle cerebral artery (MCA) in 17 patients and in the brain stem in 5 patients. This phenomenon occurred 4 hours to 4 months ( d) after stroke onset, and lasted from 1 week to 3 years ( months). Corticobulbar tract and pyramidal tract were both damaged in these 22 patients. The mechanism might be that after corticobulbar tract and pyramidal tract damaged, their dominant role in the cranial nerve nuclei of the brainstem and the anterior horn cells of the spinal cord disappeared, and the projection of oxytocinergic neurons from paraventricular nucleus functions, thus causing yawning and muscle contraction. Conclusion PBO may be a rare phenomenon of abnormal movement after stroke. This phenomenon indicates damaging of pyramidal tract, and PBO disappears gradually with the recovery of pyramidal tract function. [Key words] parakinesia brachialis oscitans; cerebrovascular disease; internal capsule; pathogenesis 1844 Bell 1 [ ] [ ] ( ) ( ) [ ] wlyingsh@163.com [1] 2005 Walusinski

2 [2] 4 (parakinesia brachialis oscitans PBO) PBO 4 PBO PBO d ( ) /d 2/5 (+) MRI (DWI) ( 1A) 3 20cm 5 3/5 9 4/ d 4/ d /5 MRI DWI ( 1B) 4 15cm 7 2/5 10 3/ d /5 4/ /5 MRI ( ) DWI ( 1C) 4 17d 2/ h h CT (0.9mg/kg) 23mg 24h CT ( 1D) cm 2d 2/5 2 yawn yawning hand up raise arm parakinesia brachialis oscitans PubMed Web of Science Clinicaltrial.gov [3-11] 1 [2] 3 [12-14] 4 PBO ~75( ) 19:3( : ) PBO 4h~4 ( d) 1 ~3 ( ) 3 Bell [15] 1982 Mulley [13] 1988 Wimalaratna [11] 1 ( 0/5 ) 1 [16]

3 Med J Chin PLA, Vol. 43, No. 3, March 1, A B D C 2h after symptom onset 24h after symptom onset 12d after symptom onset 1 4 PBO MRI CT Fig. 1 Brain magnetic resonance imaging or CT scan for the 4 patients parakinesia brachialis oscitans (PBO) A. Diffusion weighted magnetic resonance imaging of patient 1 showing right basal ganglia and internal capsule infarction; B. Diffusion weighted magnetic resonance imaging of patient 2 showing left pontine infarction; C. Diffusion weighted magnetic resonance imaging of patient 3 showing bilateral pontine, cerebellum, and right occipital lobe infarction; D. Brain CT scan of patient 4 showing lacunar infarction beside the lateral ventricle 24 hours and 12 days after symptom onset Author/Year Age (year)/ Gender 1 22 PBO Tab. 1 Clinical characteristics of 22 PBO patients PUL (MRC grade) OT DT Lesion Ischemic/ Hemorrahgic stroke 73/M 2/5 3d 10d Right basal ganglia/ internal capsule Ischemic stroke Li JY/2018 * 69/M 0/5 11d 19d Left pons Ischemic stroke 62/F 0/5 7d 20d Bilateral pons and cerebellum/right occipital lobe Ischemic stroke 66/M 0/5 6d - Beside left lateral ventricle Ischemic stroke Wimalarana/1988 [11] 65/M 0/5 - - Left internal capsule Ischemic stroke Blin/1994 [10] 62/M 0/5 - - Left internal capsule Ischemic stroke Töpper/2003 [5] 51/M 0/5 14d - Left thalamus/ internal capsule Hemorrahgic stroke 62/M 0/5 - - Right posterior/ MCA territory Ischemic stroke 43/M 0/5 4d - Basilar artery occlusion(right pons) Ischemic stroke Walusinski/2010 [6] 49/F 2/5 2d 14d Right internal capsule CADASIL 73/M 0/5 1d 7d Left internal capsule Ischemic stroke 71/M 0/5 1d 3y Right centrum semiovale/lenticular nucleus centrum semiovale and lenticular nucleus Ischemic stroke 53/M 0/5 1d 1y Right caudate nucleus/ centrum semiovale semiovale Ischemic stroke 75/M - 1d - Left internal capsule/ lenticular nucleus Ischemic stroke 35/F 0/5 1d - MCA territory Ischemic stroke de Lima/2012 [3] 39/M - - 4m Right pons Ischemic stroke 63/M 1/5 2m - Right frontotemporal cortex and subcortex Ischemic stroke 55/M - - 6m Right rostral medulla oblongata Ischemic stroke Jung/2012 [8] 59/M 2/5 1d - Right precentral gyrus/frontal subcortex gyrus and frontal subcortex Ischemic stroke Wu/2013 [7] 52/M 1/5 4m - Right putamina/ internal capsule putamen Hemorrahgic stroke Zorzetto/2013 [4] 60/M - 4h - Left MCA territory Ischemic stroke Kang/2015 [9] 63/M 0/5-14d Left middle cerebral artery Ischemic stroke *The present study; PUL. Paralyzed upper limb; OT. Occurence time; DT. Disappearance time; M. Male; F. Female; CADASIL. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; MCA. Middle cerebral artery

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