Parakinesia Brachialis Oscitans.pptx

Parakinesia Brachialis Oscitans

1. Ade Wijaya , MD – July 2022 Parakinesia Brachialis Oscitans

2. Terminology Chowdhury , A., Datta , A. K., Biswas , S., & Biswas , D. A. (2022). Parakinesia Brachialis Oscitans –a Rare Post-Stroke Phenomenon.  Tremor and Other Hyperkinetic Movements ,  12 . Walusinski O, Neau JP, Bogousslavsky J.  Hand up! Yawn and raise your arm.  Int J Stroke  2010; 5: 21–27.  

3. Yawning A homeostatic process that appears when the default-mode network is active and sleepiness increases; yawning then disengages the default-mode network to promote the attentional network Accelerates the circulation of cerebrospinal fluid, increasing clearance of somnogens such as adenosine, prostaglandin D2, VIP, prolactin and anandamide , and reducing sleepiness Walusinski O. How yawning switches the default-mode network to the attentional network by activating the cerebrospinal fluid flow. Clin Anat. 2014 Mar;27(2):201-9.

4. Pathophysiology of Yawning Collins GT, Eguibar JR. Neurophamacology of yawning. Front Neurol Neurosci . 2010;28:90-106.

5. Introduction First described at 1844 Term Parakinesia Brachialis Oscitans (PBO) first coined by Walusinski in 2010 Occurs during post-stroke recovery both flaccid and spastic phase Onset: 1 day – 4 months after stroke Usually involving upper limb  shoulder abduction False alarm of hope Lim, I. C. Z., & Neo, S. (2022). Parakinesia Brachialis Oscitans : Old Sign, New Findings.  Stroke ,  53 (2), e60-e62. Chowdhury , A., Datta , A. K., Biswas , S., & Biswas , D. A. (2022). Parakinesia Brachialis Oscitans –a Rare Post-Stroke Phenomenon.  Tremor and Other Hyperkinetic Movements ,  12 . Walusinski O, Neau JP, Bogousslavsky J. Hand up! Yawn and raise your arm.  Int J Stroke  2010; 5: 21–27. 

6. Movement Disorder Rare phenomenon of abnormal involuntary movement Parakinesia Automatic-voluntary dissociation Lim, I. C. Z., & Neo, S. (2022). Parakinesia Brachialis Oscitans : Old Sign, New Findings.  Stroke ,  53 (2), e60-e62.

7. Emotional motor system Proprioceptive loop theory yawning is thought to represent a somatic manifestation of a disinterested emotional state During a yawn, there is co-activation of bulbar and motor neurons in the brain stem, resulting in stretching movements in the upper limb via intact reticulospinal tracts The theory proposes that the strong contraction of respiratory muscles during a yawn sends a proprioceptive signal antidromically to the anterior spinal horn, cerebellum, and finally the lateral reticular nucleus in the medulla via the ventral spinocerebellar tract A motor signal from the lateral reticular nucleus is then formulated in response and travels through the extrapyramidal pathways of the cerebellum, back to the anterior horn cell from C4 to C8, resulting in the involuntary movement of the paralyzed upper limb. Pathophysiology Töpper R, Mull M, Nacimiento W . Involuntary stretching during yawning in patients with pyramidal tract lesions: further evidence for the existence of an independent emotional motor system . Eur J Neurol . 2003; 10:495–499. Walusinski O, Neau JP, Bogousslavsky J. Hand up! Yawn and raise your arm.  Int J Stroke  2010; 5: 21–27. 

8. Etiology Ischaemic stroke Hemorrhagic stroke Amyotrophic lateral sclerosis Brainstem tuberculoma Li J-y, Wu L, Sun L.-qing , Xiong J.-mei . Clinical and radiological characteristics of hemiplegic arm raising related to yawning in stroke patient. PLMAJ Med J Chinese People’s LIberation Army . 2018; 43

9. Summary Movement of the paretic arm with yawning poststroke can occur in patients with lesions along the pyramidal tract (most commonly in the internal capsule or the pons ) PBO is an example of an autonomic-voluntary dissociation. The loss of cortical inhibition of the cerebellum via the corticopontocerebellar pathway, while the spinoarcheocerebellar pathway remains functional, explains the phenomenon. This phenomenon fades as the patient progresses in their motor recovery .

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