Intractable yawning as a predominant symptom of temporal lobe ganglioglioma: Case report and review of literature

Yawning, a physiologic reflex exhibited by vertebrates, is seldom noticed as a symptom of a disease. Not too often is a patient aware of it as a symptom, unless it is of such a distressing nature to seek attention. In this situation, to distinguish between normal and abnormal behavior would pose a diagnostic dilemma for the attending physician. Intractable yawning has been a presenting symptom of many pathologic states such as stroke, epilepsy, and migraine. Literature is sparse regarding intractable yawning caused by tumors of the brain. Most of the time, the etiology cited is the infratentorial location of these tumors causing compression of the brainstem and the centers responsible for yawning. Intractable yawning as a predominant symptom of supratentorial tumor is rare. We present a case of an 18-year-old girl who presented with abnormal yawning. On evaluation, magnetic resonance imaging revealed a tumor in the posterior part of the inferior temporal gyrus. There was no significant compression of the brainstem structures to suggest this as a cause for her symptom. She underwent a craniotomy and total excision of lesion. Postoperatively, her symptoms improved and her salvos of yawns ceased. The histopathological examination revealed a ganglioglioma of the temporal lobe. The present case is unique as it is the only case reported in the literature of a supratentorial tumor causing abnormal yawning.