Forced
yawning as a pseudobulbar sign in amyotrophic
lateral sclerosis (als)
Elisabeth S. Louwerse, F. Eelco
Posthumus-Meyjes, Dirk Troost and J.M.B. Vianney
de Jong
Dept. Neurology, Academic
Centre at the University of Amsterdam, The
Nelherlands
In a series of 200 consecutive ALS patients,
23 exhibited bouts of prolonged, intensive
and uncontrolled yawning. All of the
patients with symptoms of yawning had signs of
pseudobulbar and bulbar paresis, with positive
pseudobulbar reflexes and forced crying or
forced laughter.
In one woman, bouts of yawning caused
habitual subluxation of the mandible several
times per night. Yawning caused great
embarrassment to a patient in whom it came on
whenever she was happy about being visited by
close friends. In another, we could provoke
yawning by eliciting the plantar responses.
Synchronously with the bouts of yawning, one
patient exhibited forced
extension of a paretic arm. We will report
the autopsy findings in one case.
We conclude that, like forced crying and
forced laughter, forced yawning is a sign of
pseudobulbar involvement in ALS.
de
Buck Classification des mouvements anormaux
associés à
l'hémiplégie Rev Neurol
1899;6:361-365
Furtado D.
Provocation spinale d'un réflexe de
bâillement. Rev d'oto neuro
ophtalmologie.1951;23(1):
Ghika
J., Bogousslavsky J. Dissociated
preservation of automatic-voluntary jaw
movements in a patient with biopercular and
unilateral pontine infarcts Eur Neurol
2003;50:185-188
Heusner A P
Yawning and associated phenomena Physiological
Review 1946;25:156-168
Lanari A.,
Delbono O. The yawning and stretching sign
in hemiplegics Medicina (B Aires)
1983;43(3):355-35
Liecey Nouvelle
observation de bâillement convulsif
périodique Le Courrier Médical
1879;29;334-336
Liégey Deux
observations de bâillements intermittents
Gazette médicale de Strasbourg 1851;
p118-119
Louwerse E
Forced yawning as a pseudobulbar sign in
amyotrophic lateral sclerosis J Neuroscience
Research 1998, sup, 392
Mulley G.
Assoctiated reactions in the hemiplegic arm
Scand J Rehab Med 1982;14:117-120
Ogle
JW. Arm rising during yawning The Medical
Times and Gazette. 28 february 1863 p 213
Pierre
Marie La Pratique Neurologique
Hémiplégie, mouvements
associés Masson 1911, p477-480
Pierre
Marie et Léri A. Mouvements
involontaires dans les membres paralysés
1911 Nouveau Traité de médecine et
de thérapeutique Brouardel, Gilbert,
Thoinot JB Baillière Ed 1911
p283-291
Quoirin E.
Elévation involontaire du membre
supérieur chez
l'hémiplégique lors d'un
bâillement Thèse doctorat en
médecine Poitiers 2002
Thomson HC
Associated movements in hemiplegia : their
origin and physiological significance Brain
1903;26:515-523
Töpper
R, Mull M, Nacimento W Involuntary
stretching during yawning in patients with
pyramidal tract lesions: further evidence for
the existence of an independent emotional motor
system European J Neurology 2003;10:495-499
Trautmann R. Le
bâillement Thèse Bordeaux; 1901-02;
N° 40; 86 pages
Vulpian A
Leçons sur la physiologie
générale et comparée du
système nerveux faites au Museum
d'histoire naturelle. Rédigées par
E.Brémond. Paris, Baillière,
1866
Vulpian
A Maladies du système nerveux Paris,
Doin, 1879
Walshe FMR
On certain tonic or postural reflexes in
hemiplegia with special reference to the so
called "associated movements". Brain,
1923;46:1-37
Wimalaratna HS,
Capildeo R. Is yawning a brainstem
phenomenon ? a stroke patient who stretched his
hemiplegic arm during yawning Lancet
1988;1(8580):300
