Pathological Yawning in Patients with Acute Middle Cerebral Artery Infarction: Prognostic Significance and Association with the Infarct Location

Abstract

Background: Pathological yawning is a compulsive, frequent,repetitive yawning triggered by a specific reason besides fatigue orboredom. It may be related to iatrogenic, neurologic, psychiatric,gastrointestinal, or metabolic disorders. Moreover, it could also beseen in the course of an ischemic stroke.Aims: To determine whether pathological yawning is a prognosticmarker of middle cerebral artery stroke and evaluate its relationshipwith the infarct location.Study Design: Cross-sectional study.Methods: We examined 161 patients with acute middle cerebralartery stroke, consecutively admitted to emergency department.Demographic information, stroke risk factors, stroke type accordingto Trial of Org 10172 in Acute Stroke Treatment classification, bloodoxygen saturation, body temperature, blood pressure, heart rate,glucose levels, daytime of stroke onset, National Institutes of HealthStroke Scale score (National Institutes of Health Stroke Scale score, atadmission and 24 h), modified Rankin scale (at 3 months), and infarctlocations were documented. Pathological yawning was defined as≥3 yawns/15 min. All patients were observed for 6 hours to detectpathological yawning. National Institutes of Health Stroke Scale score>10 was determined as severe stroke. The correlation between thepresence of pathological yawning and stroke severity, infarct location,and the short- and long-term outcomes of the patients were evaluated.Results: Sixty-nine (42.9%) patients had pathological yawning and112 (69.6%) had cortical infarcts. Insular and opercular infarctswere detected in 65 (40.4%) and 54 (33.5%) patients, respectively.Pathological yawning was more frequently observed in patientswith cortical, insular, and opercular infarcts (p