Senior
resident and research scholar in Internal
Medicine, Madras Medical College, Chennai,
India
Ponniah
Thirumalaikolundusubramanian
Emeritus
Professor in Internal Medicine, The Tamil Nadu
Dr.M.G.R Medical University, Chennai,
India
Arunachalam
Muthusundari
Tirunelveli
Medical College, Tirunelveli, India.
Shah
Sweni
University
of Debrecen, Medical and Health Science Center,
Debrecen, Hungary.
Excessive or pathological
yawning, is defined as a compulsive, repetitive
action that is not triggered by appropriate
stimuli such as fatigue or boredom. We will
present the first study, including all
admissions in our stroke's unit, during which we
count, analyze all the yawns that occur during
the first day after the stroke's onset, compare
clinical status and imagery. We propose to give
a new significance to them: the loss of cortical
inhibition following stroke releases a hidden
function, phylogenetically more primitive.
Face-scratching, nose-face rubbing, yawning, and
sighs are automatisms frequently reported after
epileptic seizures. These behaviours are also
considered a characteristic pattern in healthy
subjects upon waking. Movement speed and
repetition are the factors that vary, based on
whether the context is physiological (sleep,
arousal) or pathological (epileptic seizure,
stroke). These behaviours are related to the
brainstem and diencephalic activation that
occurs when the cortex is disconnected from
these areas (where the "central pattern
generators" are located) by an epileptic
discharge or a stroke. Adaptive behaviours
depend on interactions between neural networks
at various levels, requiring continuous mutual
feedback. Yawning is an exterior manifestation
of the tonic stimulation of the cortex by
subcortical structures, particularly when the
brainstem does not receive appropriate feedback
from the cortex.
Background:
Yawning is
phylogenetically ancient and associated with
stereo typed behavioral pattern.
Objective:
To describe the pattern
of associated movements observed in hemiplegic
limbs during yawning and its relationship with
gender, side of hemiplegia and tone of
muscles.
Material and
methods:
An observational study
was designed in 75 newly detected anterior
circulatory stroke patients due to ischemia or
hemorrhage in internal capsule region. The cases
were free from any arthropathy, auto immune
disease, muscular disorders and injury
deformity. The data were analyzed
statistically.
Results:
There were 48 males and
27 females, whose median age was 48 and 47
respectively. The median time for the onset of
yawning after stroke in males and females was 36
and 38 hours, respectively. Associated movements
in hemiplegic limbs during yawning were minimal
and observed in 59 (78.6%) of hemiplegics; and
significantly more in males (83%) than females
(70%), left sided (94%) than right sided
hemiplegics (64%), those with hypotonia (71%)
than hypertonia (61%), upper limb (91%) than
lower limb (83%), and proximal than distal
joint, irrespective of limb.
Conclusion:
The appearances of
associated movements in hemiplegic limbs
indicate the return of ancestral function
observed in quadrupeds. However further studies
are needed to elicit the reasons for such
variations and utilization of associated
movements in rehabilitation
programs.
Excessive or pathological yawning, is defined as
a compulsive, repetitive action that is not
triggered by appropriate stimuli such as fatigue
or boredom. We will present the first study,
including all admissions in our stroke's unit,
during which we count, analyze all the yawns
that occur during the first day after the
stroke's onset, compare clinical status and
imagery. We propose to give a new significance
to them: the loss of cortical inhibition
following stroke releases a hidden function,
phylogenetically more primitive.
Face-scratching, nose-face rubbing, yawning, and
sighs are automatisms frequently reported after
epileptic seizures. These behaviours are also
considered a characteristic pattern in healthy
subjects upon waking. Movement speed and
repetition are the factors that vary, based on
whether the context is physiological (sleep,
arousal) or pathological (epileptic seizure,
stroke). These behaviours are related to the
brainstem and diencephalic activation that
occurs when the cortex is disconnected from
these areas (where the "central pattern
generators" are located) by an epileptic
discharge or a stroke. Adaptive behaviours
depend on interactions between neural networks
at various levels, requiring continuous mutual
feedback. Yawning is an exterior manifestation
of the tonic stimulation of the cortex by
subcortical structures, particularly when the
brainstem does not receive appropriate feedback
from the cortex.
