Abstract Details

Title Excessive Yawning as an Ictal Manifestation of Post-stroke Seizures

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 046

Objective To highlight the importance of yawning as an ictal manifestation.

Background Excessive yawning (> 3 yawns in 15 minutes) has been described as a compulsive, repetitive, action not triggered by appropriate stimuli, and seen in certain pathological states like amyotrophic lateral sclerosis, brain tumors, acute anterior circulation and brainstem stroke. It has also been reported in the peri-ictal period (preceding / after seizures), or during the ictal event especially in temporal lobe epilepsy. Here we describe the case of a male patient who presented with post-stroke seizures; semiology consisting of yawning, chewing movements and right upper extremity (RUE) twitching to increase awareness of this phenomenon.

Design/Methods Retrospective chart review and literature search.

Results 59-year-old male presented with recurrent episodes of right arm shaking within 24 hours of being diagnosed with an acute left middle cerebral artery stroke predominantly involving fronto-parietal lobes. He was admitted and started on levetiracetam. While on the floor, the nursing staff noticed frequent spells of RUE twitching along with unresponsiveness. A second anti-seizure medication (phenytoin) was added, and continuous electroencephalogram (cEEG) was started after transferring patient to the intensive care unit. The cEEG captured multiple clinical seizures (status epilepticus) with semiology starting with yawning, neck extension followed by RUE twitching with or without truncal extension along with mild generalized background slowing. Over the next day, his clinical seizure semiology involved chewing movements, and yawning at the start, but at times amidst the clinical event. Perampanel and ketamine were added, which resolved the refractory status epilepticus within 48 hours. He was discharged to a long-term acute care hospital.

Conclusions

Our case describes yawning as an ictal phenomenon in a patient in post-stroke seizures. A high index of suspicion is important for seizures with this phenomenon for timely treatment of status-epilepticus.

Authors/Disclosures
Anna McDonnell PRESENTER	Mrs. McDonnell has nothing to disclose.
Parakash Pratibhu, MD (Wellstar Neurology and Headache Center)	Dr. Pratibhu has nothing to disclose.
Prashant Natteru, MBBS (Mayo Clinic Health System)	Dr. Natteru has nothing to disclose.
Salman Tarique, MD (University of Mississippi Medical Center)	Dr. Tarique has nothing to disclose.
Sameer Sharma, MD, MBBS (UMMC, department of neurology)	Dr. Sharma has nothing to disclose.
Christa O'hana S. Nobleza, MD	Dr. Nobleza has nothing to disclose.

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Abstract Details