Pathologic yawning in neuromyelitis optica spectrum disorders

- We report nine seropositive NMOSD patients with pathologic yawning.
- Nausea, vomiting and hiccups were the most frequent associated symptoms.
- Most patients had brainstem and hypothalamic symptoms.
- MRI showed brainstem or hypothalamic lesions in all patients.
- Pathologic yawning may be a frequent although neglected symptom in NMOSD.

IntroductionBrainstem, hypothalamic and cerebral symptoms may occur in neuromyelitis optica spectrum disorders (NMOSD). However, pathologic yawning has not been previously described in NMOSD patients.Patients and methodsNine AQP4-IgG seropositive NMOSD patients experienced excessive yawning not related to sleep deprivation or fatigue.ResultsPatients were female, aged 19-57 years (median, 39 years) at disease onset. Excessive yawning spells were the presenting symptom of the disease in five patients, lasted 2-16 weeks, and usually occurred in association with nausea, vomiting and hiccups. Brain MRI was abnormal in all patients and most frequently showed brainstem and hypothalamic lesions.ConclusionPathologic yawning may be a neglected although not a rare symptom in NMOSD.