Exercise-Induced Yawning-Fatigue Attacks

A 59-year-old man developed recurrent attacks of yawning, fatigue, and sleepiness triggered by exercise of the right leg after an L4-5 disc herniation 8 years prior. This video illustrates his attacks: he has no symptoms walking at a speed of 5 km per hour for 5 minutes or walking sideways right leg first at 1.5 km per hour for 1.5 minutes (00:18), but increasing the incline to 3% (00:25) triggers an attack of yawning, fatigue, and sleepiness, forcing the patient to lie down. Click the article link for full details of the proposed mechanism and how the patient was managed.