ISSN : 2146-3123
E-ISSN : 2146-3131

Pathological Yawning in Patients with Acute Middle Cerebral Artery Infarction: Prognostic Significance and Association with the Infarct Location
Aslı Aksoy Gündoğdu1, Atilla Özcan Özdemir2, Serhat Özkan2
1Department of Neurology, Tekirdağ Namık Kemal University School of Medicine, Tekirdağ, Turkey
2Department of Neurology, Eskişehir Osmangazi School of Medicine, Eskişehir, Turkey
DOI : 10.4274/balkanmedj.galenos.2019.2019.7.49

Background: Pathological yawning (PY) is a compulsive, frequent, repetetive yawning triggered by a specific reason besides fatigue or boredom. It may be related to iatrogenic, neurologic, psychiatric, gastrointestinal or metabolic disorders. PY could also be seen in the course of ischemic stroke.
Aims: We aimed to determine whether PY is a prognostic marker of middle cerebral artery (MCA) stroke and evaluate its relationship with the infarct location.
Study Design: Cross-sectional study
Methods: We examined 161 patients with acute middle cerebral artery stroke who were consecutively admitted to emergency department. Demographic information, stroke risk factors, stroke type according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, blood oxygen saturation, body temperature, blood pressure, heart rate, glucose levels, daytime of stroke onset, National Institutes of Health Stroke Scale (NIHSS, at admission and 24 h), modified Rankin Scale (mRS, at 3 m) and infarct locations were documented. PY was defined as ≥3 yawns/15 min. All patients were observed for 6 hours to detect PY. NIHSS>10 was determined as severe stroke. The correlation between the presence of PY and stroke severity, infarct location and the short and long term outcomes of the patients were evaluated.
Results: Sixty-nine (42.9%) patients had PY and 112 (69.6%) patients had cortical infarcts. Insular and opercular infarcts were detected in 65 (40.4%) and 54 (33.5%) patients respectively. PY was more frequently observed in patients with cortical, insular and opercular infarcts (p<0,05). PY was related to higher NIHSS scores. Patients with severe stroke (NIHSS≥10) presented with more PY than mild to moderate strokes (p<0.05).
Conclusion: PY in MCA stroke is associated with stroke severity, presence of cortical involvement, insular and opercular infarcts. However no association was found regarding long term outcome and mortality.

Keywords : Pathological yawning, middle cerebral artery infarction, anterior cerebral circulation, infarct location, prognosis

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