Objective: To describe a rare case of parakinesia brachialis oscitans (PBO) with yawning-associated penile erection and truncal seizures in a patient with a right middle cerebral artery hemorrhagic stroke.

Background: Parakinesia brachialis oscitans (PBO) is an involuntary, yawning-associated movement of a plegic upper limb, first described in 2010. It is most commonly associated with middle cerebral artery lesions. However, its co-occurrence with yawning-induced penile erection and truncal seizures has not been previously reported. The mechanisms underlying these phenomena remain unclear.

Method: Medical record and video review

Results: A 76-year-old right-handed man presented with acute left-sided weakness. Neurological examination revealed left facial asymmetry, upper limb strength of 2/5, and lower limb strength of 1/5. MRI showed a hyperacute right frontal intracerebral hemorrhage at the cortical-subcortical medial precentral gyrus. During admission, he exhibited repetitive involuntary elevation of his paretic left arm during yawning, accompanied by spontaneous penile erection. He was unable to reproduce these movements voluntarily. Additionally, he had two brief episodes of painless truncal contractions without loss of consciousness. These truncal movements were wave-like, involving rhythmic, undulating contractions of the abdominal and lower thoracic muscles, lasting 1-2 minutes before spontaneously resolving. EEG was normal, though no abnormal movements occurred during the recording. Clonazepam was initiated. No further recurrence of abdominal movements was noted thereafter.

PBO likely results from disinhibition of subcortical motor pathways due to cortical damage, allowing reflexive limb movement during yawning. The yawning-associated penile erection may be due to an impaired cortical inhibitory influence on oxytocinergic spinal pathways, which regulate both yawning and erection. The truncal seizures may correspond to epileptic activity originating in the affected motor cortex region, responsible for axial motor control.

Conclusion: This case presents an unprecedented triad of yawning-induced PBO, penile erection, and truncal seizures following intracerebral hemorrhage. These findings suggest a shared neurophysiological basis related to disrupted cortical modulation of subcortical motor and autonomic pathways.

References: Aaron, S., & Hashmi, A. A. (2019). Parakinesia brachialis oscitans due to brain stem infarct. Dubai medical journal.
Andersson, K. E. (2001). Neurophysiology/pharmacology of erection. International journal of impotence research, 13.
Celada, P., Puig, M. V., Casanovas, J. M., Guillazo, G., & Artigas, F. (2001). Control of doral raphe serotonergic neurons by the medial prefrontal cortex: Involvement of serotonin-1a, gaba-a, and glutamate receptors. The journal of neuroscience, 21(24), 9917-9929.
Dorocic, I. P., Furth, D. Xuan, Y., Johansson, Y., Pozzi, L., Silberberg, G. Carlen, M., Meletis, K. (2014). A whole-brain atlas of inputs to serotonergic neurons of the dorsal and median raphe nuclei. Neuron, 83, 663-678.
Farah, M., Barcellos, I., Boschetti, G., & Munhoz, R. P. (2015). Parakinesia brachialis oscitans. Movement disorders clinical practice.
Gupta, S., & Mittal, S. (2013). Yawning and its physiological significance. International journal of applied and basic medical research, 3(1), 11. doi:10.4103/2229-516x.112230
Gupta, A., & Kushwaha, S. (2017). Belly dancer’s dyskinesia: A glimpse of a rare phenomenon. Cureus, 9(7): e1457.
Iliceto, G., Thompson, P. D., Day, B. L., Rothwell, J. C.., Lees, A. J., & Marsden, C. D. (1990). Diaphragmatic flutter, the moving umbilicus syndrome, and belly dancer’s dyskinesia. Movement disorders, 5(1), 15-22.
Jung, N. Y., Ahn, B. Y., Park, K. Y., Chung, C. S., Na, D. L., and Kim, E. J. (2012) A case of parakinesia brachialis oscitans. Clinical neurology and neurosurgery, 114, pp. 1560158.
Lizarraga, K. J., Serrano, E. A., Tornes, L., Kanner, A. M., & Lang, A. E. (2019). Isolated abdominal motor seizures of mesial parietal origin: Epileptic belly dancing? Movement disorders clinical practice.
McKenna, K. E. (2000). Some proposals regarding the organization of the central nervous system control of penile erection. Neuroscience and biobehavioral reviews, 25, 535-540.
Rampin, O., & Guiliano, F. (2001). Brain control of penile erection. World journal of urology, 19:1-8.
Walusinski, O., Neau, J. P., & Bogousslavsky, J. (2010). Hand up! Yawn and raise your arm. International volume of stroke, 5, pp. 21-27.
Walusinski, O. (2019). Pathological yawning, laughing and crying.
Yeh, J. Y., Tu, K. Y., Tseng, P. T., Lee, Y., & Lin, P. Y. (2018). Acute onset of abdominal muscle dyskinesia (“belly dancer syndrome”) from quetiapine exposure: A case report. Clinical neuropharmacology.
Zorzetto, F. P., Braatz, V. L., Walusinski, O., & Teive, H. A G. (2013). Parakinesia brachialis oscinats during thrombolytic therapy. Bmj case reports.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/yawning-associated-parakinesia-brachialis-oscitans-penile-erection-and-truncal-seizures-following-intracerebral-hemorrhage/