Reader Response: Teaching Video NeuroImages: Pathologic Yawning: A Sign of Brainstem Involvement in Acute Disseminated Encephalomyelitis?

With interest, we read the article by Birca et al.1 describing a 15-year-old adolescent boy with acute disseminated encephalomyelitis (ADEM) and a dorsal brainstem lesion who presented with pathologic yawning. We previously reported a 20-year-old man with antimyelin oligodendrocyte glycoprotein (MOG) antibody-associated brainstem encephalitis that involved the dorsal brainstem and cerebellum.2 Our case also presented with pathologic frequent yawning in addition to nystagmus, decreased hearing, and truncal ataxia on admission, although we did not describe these additional findings in detail in the article. Because it is well known that almost half of pediatric patients with ADEM are MOG-IgG seropositive3—and because MOG-IgG-associated brainstem encephalitis might relapse, as in our case—serum MOG-IgG status should be determined in this case as well.

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