Video 1
Hemiplegia. Shows weakness of right upper limb.
Video 2
PBO. Shows involuntary movement of right upper limb during yawning.
Figure 1
Axial T1 weighted MR image shows irregular signal characteristics in left lateral frontal cortex and white matter extending to operculum, precentral gyrus, sylvian cortex (blue arrow) as well as gliosis in right putamen and head of caudate nucleus (red arrow).
Figure 2
Axial Gradient Echo Image shows internal hypointense foci with blooming effect suggesting haemorrhage (red arrows).
Figure 3
MR angiogram shows loss of flow signal in intracranial left internal carotid artery (blue arrow), left middle cerebral artery (green arrow) and A1 segment of left anterior cerebral artery (red arrow). Left vertebral artery (yellow arrow) remains non visualized.
Table 1
Comparison of cases of parakinesia brachialis oscitans (PBO) described in literature.
| SR NO. | REFERENCES | AGE/SEX | SITE OF LESION | INFARCT/HAEMORRHAGE | PBO ONSET | DURATION OF PBO | MOVEMENT DESCRIPTION |
|---|---|---|---|---|---|---|---|
| 1. | Blin et al. (France -1993) [6] | 62/M | Posterior limb of left internal capsule | Infarct | Few days from stroke onset | >6 weeks | Abduction, antero-flexion and internal rotation of shoulder with mild flexion of elbow and extension of fingers |
| 2. | Topper et al. (Germany- 2002) [7] | 62/M | Total Right MCA territory | Infarct | NA | Spontaneous movements of left arm during yawning | |
| 51/M | Left thalamus and posterior portion on internal capsule | Haemorrhage | After 2 weeks from stroke onset | NA | Right shoulder abduction with extension of right forearm and fingers | ||
| 43/M | Right sided pons extending to cerebellar peduncle | Infarct | After 4 days from stroke onset | NA | Abduction and extension of left arm | ||
| 3. | Walusinski et al. (France – 2010) [1] | 49/F | Posterior limb of right internal capsule | Infarct | After 2 days from stroke onset | 2 weeks | Hemiplegic arm rising up to the level of chest |
| 73/M | Anterior limb of left internal capsule | Infarct | NA | 1 week | Hemiplegic arm 30 cms upwards moving | ||
| 71/M | Right centrum semiovale and lenticular nucleus | Infarct | From stroke onset | >3 years | Rising of left arm with adduction and elbow flexion | ||
| 53/M | Right centrum semiovale and caudate nucleus | Infarct | From stroke onset | >1 year | Rising of left arm with adduction and elbow flexion | ||
| 75/M | Left internal capsule and lenticular nucleus | Infarct | From stroke onset | NA | Rising of right arm with adduction and elbow flexion | ||
| 35/F | Total left MCA territory | Infarct | From stroke onset | NA | Rising of right arm elbow Flexion | ||
| 4. | Jung et al. (Republic of korea – 2011) [8] | 59/M | Right precentral gyrus and frontal subcortex | Infarct | Day 2 | NA | Left arm rising with adduction and elbow flexion |
| 5. | de Lima PM et al. (Brazil- 2011) [2] | 63/M | Right cortical/subcortical fronto-parietal region | Infarct | After months 2 | NA | Abduction and elevation of left arm with minimal extension of forearm |
| 39/M | Base of right pons | Infarct | From stroke onset | Approx 4 months | Rising of left arm (abduction and flexion) with extension of lower limb | ||
| 55/M | Right rostral medulla | Infarct | From Stroke onset | NA | Left Upper and Lower limb presented with contractures while yawning | ||
| 6. | Zorzetto et al. (Brazil – 2013) [9] | 60/M | Left MCA territory | Infarct | From stroke onset | 24 hours | Rising of right arm with adduction and elbow flexion |
| 7. | Yung-Tsan Wu et al. (Taiwan – 2013) [10] | 52/M | Right putamen | Haemorrhage | 4 months after stroke | NA | Abduction and mild internal rotation of shoulder with elbow flexion |
| 8. | Farah et al. (Canada – 2015) [3] | 51/M | Left fronto-parieto-temporal region | Infarct | After 2 days | 12 hours | Rising of right arm associated with tremor |
| 9. | Kang P, Dhand A (USA – 2015) [12] | 63/< | Left MCA territory involving cortical and subcortical structures | Infarct | From stroke onset | NA | With yawning, right arm consistently rose to chest, movement ceased after 2 weeks following partial recovery of arm strength (MRC grade 4) |
| 10. | Alves PN et al. (Portugal – 2017) [4] | 59/M | Left MCA territory involving the anterior limb of internal capsule, and of the anterior, posterior, and inferior regions of putamen | Infarct | From stroke onset | Reflexive, stereotyped movement of flexion of the right elbow while yawing. On day 6, the patient started to have voluntary control over that movement, during more sustained yawning, he could even perform more complex movements of distal joints, e.g. grabbing objects purposely. These movements could also be volitionally suppressed. | |
| 11. | Aaron et al. (Oman – 2019) [11] | 53/M | Right pons and upper medulla | Infarct | After 2 days | 3 days | Rising of left arm with yawning |
| 12. | Present case (India – 2021) | 59/M | Left frontal cortex and basal ganglia | Infarct | After 2 weeks | >1 year | Abduction of shoulder, flexion and mild supination at elbow and intermittently associated with dorsiflexion of wrist |