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mise à jour du
13 mars 2011
lexique
Involuntary arm elevation during yawning in a hemiplegic patient
 
Na-Yeon Jung ,Bo-Young Ahn , Kyu-Hyun Park , Chin-Sang Chung , Duk L. Na , Eun-Joo Kim
 
Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine
 

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Tous les articles sur la parakinésie brachiale oscitante 
All articles about parakinsia brachialis oscitans
 
 
There have been few described cases of hemiplegia with involuntary elevation of paralyzed arms while yawning, symptoms referred to as parakinesia brachialis oscitans.
 
Brain imaging shows lesions mainly associated with internal capsule or pons. We report a patient with involuntary hemiplegic arm raising during yawning after acute infarction involving the right motor cortex and frontal subcortex. Case : A 59-year-old man presented with sudden onset of left-sided weakness.
 
On admission, neurological examinations revealed alert mental state, a left hemiplegia (MRC grade 2/5 in the left upper limb, 3/5 in the left lower limb) and dysarthria. Sensory exam was unremarkable. Deep tendon reflexes were asymmetrically brisk on the left. Babinski's sign presented on the left. Diffusion weighted magnetic resonance imaging (MRI) demonstrated increased signal intensities on the right precentral gyrus and frontal subcortex. One day after the stroke, the patient's wife reported that his left hemiplegic arm was spontaneously elevated every time he yawned (video).
 
This peculiar phenomenon persisted during a 17 day admission period. At the last contact with the patient's family five years after the stroke onset, his left hemiplegia still continued with the MRC grade of about 3/5, however, abnormal movement in his hemiplegic arm during yawning disappeared.
 
Conclusions or Commentes : The underlying mechanism of parakinesia brachialis oscitans has yet to be clarified. However, activated projections from disinhibited subcortical structures to the brain stem extrapyramidal motor control systems or the existence of an independent emotional motor pathway has been suggested as the possible pathophysiological explanation for the association between involuntary movements of the hemiplegic arm and yawning.