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Neurological Rehabilitation

(Kiosk 4) Parakinesia Brachialis Oscitans Following Acute Middle Cerebral Artery Ischemic Stroke: A Case Report

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Lanah Koh, DO

    Resident Physician
    University of New Mexico School of Medicine PM&R Program
    Albuquerque, New Mexico

    • Co-Author(s)

  • TP

    Tram Pham, DO

    Resident Physician
    University of New Mexico School of Medicine PM&R Program
    Albuquerque, New Mexico

  • Kari J. Rezac, DO (she/her/hers)

    Resident Physician
    University of New Mexico School of Medicine PM&R Program
    Sacramento, California

Case Diagnosis: Parakinesia brachialis oscitans

Case Description or Program Description: A 29-year-old female with a history of polysubstance abuse, including methamphetamine, presented to the acute inpatient rehabilitation hospital two weeks after an acute ischemic stroke. Brain MRI showed infarction in the right middle cerebral artery (MCA) territory involving the M2 and M3 branches of the MCA. Patient was noted to have involuntary left elbow flexion with wrist dorsiflexion of the left paretic upper limb in synchrony with yawning, consistent with parakinesia brachialis oscitans (PBO). The rehabilitation plan attempted to leverage PBO for motor recovery and activities of daily living. While she did exhibit significant motor recovery (muscle strength from 0 to 3) over her three-week inpatient rehabilitation stay, she remained unable to reliably use PBO to gain further functional improvement. Two months after discharge, PBO was no longer observed.

Setting: Acute inpatient rehabilitation hospital

Assessment/Results: PBO is the phenomenon of involuntary movement of a paralyzed limb during yawning. The precise mechanism underlying the pathophysiology and its role in neurorehabilitation after stroke is not fully understood. While PBO in particular is rare, post-stroke movement disorders are comparatively common in the U.S. with thousands of patients affected annually. Movement disorders frequently occur during the subacute phase of stroke recovery and can disrupt therapy participation as well as quality of life. Thus, it is important that a physiatrist is cognizant of the clinical implications of movement disorders in stroke rehabilitation in order to optimize therapeutic strategies.

Discussion (relevance): To our knowledge, PM&R training does not routinely incorporate evidence-based management of post-stroke movement disorders and associated therapy approaches.

Conclusions: This PBO case offers an interesting, albeit rare, illustration of post-stroke movement disorders. It highlights the untapped potential to leverage these phenomena for functional improvement. It also exposes an important gap in PM&R trainee curricula that should be considered by the leadership in the future curriculum updates.