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We present a case and video of a 31-year-old man with biopsy-confirmed tumefactive demyelination affecting the right internal capsule causing left hemiplegia, excessive yawning, and the curious but well-described phenomenon of parakinesia brachialis oscitans (PBO) with transient tonic elevation of his paralyzed arm while yawning. PBO is most commonly reported in ischemic stroke with internal capsule or pontomedullary brainstem lesions. Our case uniquely demonstrates this phenomenon in the case of tumefactive demyelination.

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

Neurol Clin Pract

December 2023

Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.

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.

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Background: Abnormal involuntary movement of paralyzed upper limb during yawning is a rare phenomenon termed as parakinesia brachialis oscitans.

Case Report: We describe a 59-year-old gentleman with abnormal involuntary movement of paralyzed right upper limb during yawning 2 weeks following ischemic stroke of left middle cerebral artery territory.

Discussion: This is a rare post-stroke phenomenon and its pathophysiological mechanism is poorly understood but this entity highlights possible preserved extrapyramidal pathway which might help in rehabilitating stroke survivors.

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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.

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