mystery of yawning
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal



mise à jour du
15 septembre 2005
Diencephalic autonomic seizures
W Penfield, H Jasper
extraits de
Eplilepsy and the functionnal anatomy of the human brain
Little Brown et copany - Boston
Yawning and epilepsy


This chapter will be devoted to sensations and bodily changes that seem to be related to the viscera. These are phenomena that may be called visceral seizures, both sensory and motor.
The visceral auras were extensively described by Gowers (1901). He related them to the innervation of the pneumogastric nerve but made no attempt to consider these phenomena as anything more than auras. Wilson (1929) has referred to what he called vasovagal attacks of Gowers, and reported certain cases in which visceral phenomena were well described.
In Chapter III a section was devoted to autonomic responses and this section should serve as an introduction to the following discussion. The major concentration of functional representation of autonomie systems is to be found in the diencephalon and there is well-known control in the medulla oblongata as well. But some of these functions are found to have representation in the cerebral cortex.
Autonomic specializations in the cerebral cortex. In the cortex the representation is apt to be related to various motor specializations. For example, to name only a few of the delegations of autonomie control to the cortex: respiration is controlled, for the purposes of vocalization, in each of the four vocalization areas (supplementary motor and lower Rolandic motor, right and left hemisphere). Respiration is inhibited when the activity of the swallowing is produced in the lower Rolandic motor area. Respiration is influenced likewise by stimulation of the olfactory cortex and the anterior inferior portion of the cingulate gyrus.
Pupillary change may be produced by discharge in, or stimulation of, the occipital visual areas and also in the precentral area from which conjugate eye turning is produced, also in the supplementary motor area when contraversive looking movements are produced. Pupillary change occurs when certain psychical states are produced, such as the emotion of fear, by discharge in the temporal cortex.
It is obvious that no useful purpose would be served by an attempt to separate these phenomena from the motor or sensory or psychical specialization of which they form a part. It is also idle to inquire as to whether vision, hearing, equilibration, tasting, and smelling, which have been treated as somatic, should have been classed as visceral.
In most cases there can be no complete segregation of autonomic phenomena from somatic phenomena. But there are rare examples of exclusive autonomic seizures. In such cases there seems to be a diencephalic localization as exclusive as the cortical localization of a simple Jacksonian motor seizure.
The sense of taste has already been considered with the somatic sensations and salivation, likewise, because of its representation in the lower sensorimotor cortex. Salivation is also represented in the diencephalon, as indicated by the report of CASE J.HL. to follow.
Priapism is a rare occurrence during a seizure. We have had one adult, whose attacks were due to a large meningeal fibroblastoma underneath one frontal lobe, who had priapism during major attacks. There was also one child of 19 months, C.Gn., who had a very large cyst of the right hemisphere. His attacks during status epilepticus were first on one side, then on the other. At one time they were chiefly truncal, and priapism appeared for about half an hour. There appeared with it flushing of the face in a blotchy manner. We have never produced erection by stimulation and have no conception as to its relationship to cerebral hemispheres.
Complicated seizures in which all the manifestations are autonomic are rare, but they do occur and are of great anatomical importance. Such an example was described by Penfield (1929b). This case1 may now be summarized: pupillary control, and at least certain of the mechanisms for discharging gland secretions-tears, sweat, saliva. It is interesting that evidence of gastrointestinal activity was absent. There was no vomiting, no borborygmus, no defecation, although there may well have been gastrointestinal activity of which no evidence was seen. It is obvious that the term "vasovagal" is hardly descriptive of such a case as this. There was micturition only on one occasion.
When the attacks became more severe there was loss of consciousness and this occurred without somatomotor involvement. The discharge seems to have spread directly to include the neural mechanisms essential to consciousness, just as it does in an otherwise exclusively somatomotor discharge as soon as the intensity becomes great enough.
Since observing this case, we have had numerous opportunities to verify the existence of visceromotor representation in this area.
In CASE H.C. (Case Index), stimulation close to the infundibulum produced flushing of face and neck and erythema. In CASE P.M. there was a tumor similarly placed in the vicinity of one foramen of Monro. At operation under local anesthesia, the maneuver of scraping out the tumor produced an attack of marked urticaria and itching.
A complicated case of autonomic seizures has been reported by Engel and Aring (1945). The patient had a discrete cyst in the region of the right dorsomedial nucleus of the thalamus, the hypothalamus being intact. The "hypothalamic attacks" were characterized by choryza, chills, fever, nausea, vomiting, abdominal cramps, and ohguria and associated with fluctuating hypertension and tachycardia. The authors were under the impression that this complicated train of events could be precipitated by anxiety, and the patient died during such a seizure which was precipitated thus.
In many cases of infiltrating tumors mixed seizures occur (autonomic and somatic) or two distinct types may appear, as in the following example:
CASE M.PN. Tumor of temporal lobe and basal ganglia, autonomic seizures.
This woman of 29 years had minor attacks for 6 years, and major attacks for 5 years, with uncinate symptoms present for 2 years. On admission to the hospital, she had a right homonymous hemianopsia, right lower facial weakness, and a positive sign of Babinski on the right.
While in hospital she had attacks of several distinct types, which were carefully observed and analyzed as follows: (1) Frank adversive seizures, which began with turning of head and eyes to the right and which were followed by aphasia. (2) Autonomic seizures with headache. The head began to ache rather suddenly in the occipital region and back of neck. This was usually associated with yawning and often with hiccups. She nearly always wanted to void during such attacks or afterward. Associated with this there was numbness of the left arm and left mouth, and once there was cyanosis of the left hand. During these attacks she was hypersensitive to being touched as though there were a generalized hyperesthesia. Occasionally aphasia and increase in the right facial weakness followed such attacks.
(3) Autonomic seizures. The most dramatic of these occurred at 2:15 A.M. on the day of her death. It was recorded completely by Nurse M. Hall: "The patient opened her eyes, looked at the nurse and smiled with the left side of her face. She was placed on bed pan. During the process, both arms suddenly straightened out in a rigid posture (this seems to suggest a tonic postural seizure. It is not clear whether the attitude resembled decerebrate rigidity or not); eyes turned to the right and then back; right pupil contracted and left dilated. Pulse became rapid and weak. Respirations became slowed to 4 per minute. There was drooling from the mouth; tears in both eyes.
"Then a deep flush was noticed on both arms and also appeared on chest and face. It was observed that in contrast with the flushing of the rest of the face there was pallor on either side of the nose and upper lip. On the epigastrium in the midline a blotchy red erythema appeared. Rash and flush disappeared slowly, 12 to 15 minutes. About the time the flush had gone the pupils were observed to be equal. They remained so for less than a minute, after which they were reversed and the left pupil became small and the right one large for a time and then they became approximately equal again."
During this autonomic seizure the blood pressure was taken once and found to he 200 systolic and 100 diastolic, although her pressure ordinarily was 120 over 80. Miss Hall noted irregularities in the pulse during periods of recurring slowing of the respiration. The pulse might then be full, and suddenly miss one or two beats, and then perhaps be weak and rapid. The pulse rate however rose to 150 and continued to rise to 180 during the remaining 8 hours of her life.
There was one more seizure, a slight one at 6:30 A.M. In this attack there was a tremor of the right side of the face, followed by flushing and "goose flesh" over thorax and legs. There was marked puckering of the nipple and a rash appeared, though fainter than in the first attack. The attack lasted about one minute.
The rapid rate of the heart continued. The diastolic pressure remained elevated to 110, the systolic fell to 124, the pulse pressure becoming smaller, and circulation failed gradually in spite of stimulation.
Autopsy was carried out at once and the heart removed one hour and 40 minutes after death. Immediate examination showed the glycogen to be 0.348 gm. per cent (as glucose) and the lactic acid 0.624 gm. per cent. This low figure would indicate that death was probably due to heart failure from the high rate at which it had been driven by the autonomic centers. We have been forced to a similar conclusion in regard to death following neurogenic hyperthermia in certain cases. Examination of the brain showed a large astrocytoma occupying the whole left temporal lobe and lower portion of corpus striatum, while a cyst extended to the midline and wall of the third ventricle.
It seems quite likely that the headache, of which she sometimes complained, was the result of the elevation of blood pressure that occurred with her autonomie attacks.
The following case may be recorded here in which yawning was the most striking phenomenon, but which included other phenomena exhibited by J.HL. above.
CASE L.J. Autonomic seizures.
This young man was referred to us by Dr. Albert Brousseau of Quebec because of attacks of yawning. There was a history of head injury but no evidence of a cerebral lesion. His attacks of yawning varied in duration from a few minutes to 3 hours.
Each attack was ushered in by sweating of hands and scalp, and a prickling sensation in scalp and back as though all the hairs were standing up. He felt his heart pounding at these times, and a feeling that things were going away from him, and, weakness, so he had to sit or lie down. He would then yawn continuously and tears would flow from his eyes.

penfield jasper
Wilder Penfield and Herbert Jasper 1954
Dr. Wilder Penfield révolutionna les techniques de chirurgie du cerveau. Il est l'auteur de découvertes importantes portant sur la mémoire, la sensibilité et la douleur, la cognition.
Ces travaux commencèrent en recherchant la cause et le traitement d'épilepsies jusqu'alors incurables. Il fonda l'Institut neurochirurgical de Montreal en 1935, original par l'association de chirurgiens, physiologistes et chercheurs au sein de la même structure vouée tant à la recherche, qu'aux diagnostics et aux traitements de la pathologie cérébrale.
C'est à l'Institut que Penfield perfectionna "la procédure montréalaise". Recourant à la seule anesthésie locale, il enlevait le volet osseux, mettant à nu le cerveau. Guidé par les réponses du patient, il recherchait la région génératrice des crises. Cette technique lui permit aussi d'apporter sa contribution à l'ère des localisations cérébrales tant pour la mémoire que pour les émotions. Voir la vidéo.
The influence of the diencephalon and hypophysis upon general autonomic function
The canadian Medical Assotiation Journal June 1934
A woman of 29, with a tumour involving the under surface of the left temporal lobe and extending to the midbrain and thalamus. She had had recurring slight attacks consisting of sudden headache, followed by yawning and hiccuping and sometimes associated with patchy erythema in different areas of the body. There was one attack of greater severity, characterized by a rise of blood pressure to 200 over 90, whereas the usual level approximated 100 over 70. With this there was a simultaneous rise of the pulse rate to 120, flushing and appearance of irregular erythema over the chest and thighs, spontaneous appearance of "goose flesh", slowing of the respirations to 4 per minute, salivation, lacrimation, dilatation of the left pupil, and contraction of the right.
"Diencephalic autonomic Epilepsy"
This description tallies sufficiently with the first to make it clear that we are not dealing with a discharge of a parasympathetic system alone, as Cushing concludes in reviewing the first ease. It is an explosive, undiscriminating, discharge which betrays the spatial relationships both of parasympathetic and sympathetic function. The dilatation of the peripheral vessels and sweating might be considered as parasympathetic in nature, but the pilomotor response and increased pulse rate, increased blood pressure, and protrusion of the eyes obviously belong in the sphere of the sympathetic. Another instance may be cited.
Dr. Wilder Penfield revolutionized the techniques of brain surgery and made major discoveries about human cognition, memory and sensation.
Penfield's medical exploration began with the causes and treatment of epilepsy, which was considered incurable. In 1935 he set up the Montreal Neurological Institute, which brought together surgeons and scientists for cooperative projects in the research, diagnosis and surgical treatment of brain disorders.
At the Institute, Penfield perfected his "Montreal Procedure." Applying only a local anaesthetic, he would probe the exposed brain tissue. Guided by the responses of the patient, Penfield would search for the scarred tissue that caused the epilepsy. This procedure also revealed specific functions performed by various unmapped regions of the brain. Penfield discovered the source of memory, tapped the reservoir of long forgotten sensations and emotions, and located the storehouse of dreams. See the video
Improvements in brain tumor surgery: the modern history of awake craniotomies
Ketan R. Bulsara et al. Neurosurgical Focus 2005; 14; 4; 1-5
Qu'est-ce qu'un bâillement
Bâiller : l'étymologie
Quand bâillons-nous ?
Interprétations historiques
Pourquoi bâillons-nous?
Contagion du bâillement (2009)
Neurophysiologie du bâillement
en anglais, yawning
Schémas anatomiques, embryologie
Sémiologie et examen clinique
Complications : manoeuvre de Nélaton
Bâillements pathologiques
Bâillements iatrogènes
Enquête en médecine générale
Observations et cas cliniques
Les mystères restant à éclaircir
Neural basis of drug induced yawning
Visiter des sites sur le sommeil
Visiter des sites médicaux et bibliothèques
Imprimer des textes du site
Les critères éthiques du site
L'actualité du site
Répondre au sondage du site
L'auteur : Dr O. Walusinski
Recherche par thèmes
Recherche par mot du site :

avec l'aide de

Index du site
Le bâillement vu par les peintres
Du bâillement en littérature
Télécharger textes du site
La lettre d'information du site
 mystery of yawning
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
w penfield
Wilder Penfield (left) and William Cone
Royal Victoria hospital 1932