Pathological Laughter as an Unusual Manifestation of Acute Stroke

Oh, Kyungmi; Kim, Ho Jung; Kim, Byung Jo; Park, Kun Woo; Lee, Dae Hie

doi:10.1159/000109573

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…[ 5 ] Interruption of cortico-pontine-cerebellar pathways including the ventral pontomedullary laughing center has been implicated for pathological laughter in PCA stroke. [ 8 12 13 ] Memory impairment in our case might be due to involvement of lateral posterior choroidal arteries (branch of PCA), feeding inferomedial portion of temporal lobe, hippocampal gyrus, and hippocampus. Pain in the left half of body at earliest which improved later indicates thalamic involvement by thalamogniculate branches.…”

Section: Discussionmentioning

confidence: 85%

Early Marked Behavioral Symptoms in Bilateral Posterior Cerebral Artery Stroke: A Disguised Presentation

Khanra¹,

Paul²,

Mukherjee

2018

Indian Journal of Psychological Medicine

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Clinical signs and symptoms of posterior cerebral artery (PCA) stroke are varied and can be challenging to diagnose at early stage. A case of bilateral PCA infarct presenting with marked behavioral symptoms and minimal neurological symptoms is presented here. A 34 years old female had presented with marked behavioral symptoms, blurring of vision and tingling sensation in left half of body. Though the latter complaints resolved following day, her behavioral complaints persisted. Magnetic Resonance Imaging (MRI) of brain revealed acute non-hemorrhagic infarct in bilateral PCA territory. Psychotropics were beneficial for her behavioral symptoms. Isolated behavioral symptoms in PCA stroke led to speculate anatomical substrate for those symptoms. We discussed possible anatomical substrates for behavioral symptoms. Our case adds to the existing literature on a range of disguising presentations in PCA stroke and also emphasizes those distinctions between ‘neurological’ or ‘psychological’ or ‘psychiatric’ disorders are often sketchy.

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Section: Discussionmentioning

confidence: 85%

Early Marked Behavioral Symptoms in Bilateral Posterior Cerebral Artery Stroke: A Disguised Presentation

Khanra¹,

Paul²,

Mukherjee

2018

Indian Journal of Psychological Medicine

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“…Although some reports show relationship of the left cerebral hemisphere to the production of laughter, 14 , 15) this case illustrates non-dominant hemisphere also have at least some influence. Although precise mechanism of pathological laughing is still unclear, extensive research to locate a precise area responsible for pathogenesis of pathological laughing has been done, but the following brain regions, namely basis pontis, 12 , 13 , 16 , 17) cerebellar white matter and gray matter, 18) basal ganglia, frontoparietal area, middle cerebral artery territory, 11 , 14 , 19 , 20) and frontal lobe 21) are advocated. In addition, by the study with ALS patients, McCullagh and Feinstein insisted the importance of the prefrontal cortex.…”

Section: Discussionmentioning

confidence: 99%

Effective Use of Sertraline for Pathological Laughing after Severe Vasospasm Due to Aneurysmal Subarachnoid Hemorrhage: Case Report

Takeuchi¹,

Iwamoto²,

Mukai³

et al. 2014

Neurol. Med. Chir.(Tokyo)

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Pathological laughing, one subgroup of psuedobulbar affect, is known as laughter inappropriate to the patient's external circumstances and unrelated to the patient's internal emotional state. The authors present the case of a 76-year-old woman with no significant medical history who experienced pathological laughing after subarachnoid hemorrhage (SAH) due to rupture of an aneurysm, which was successfully treated with craniotomy for aneurysm clipping. In the acute stage after the operation she suffered from severe vasospasm and resulting middle cerebral artery territory infarction and conscious disturbance. As she regained consciousness she was afflicted by pathological laughing 6 months after the onset of SAH. Her involuntary laughter was inappropriate to the situation and was incongruent with the emotional state, and she could not control by herself. Finally the diagnosis of pathological laughing was made and treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI), effectively cured the symptoms. Her pathological laughing was estimated to be consequence of infarction in the right prefrontal cortex and/ or corona radiata, resulting from vasospasm. To the authors' knowledge, this is the first report of pathological laughing after aneurysmal SAH. The authors offer insight into the pathophysiology of this rare phenomenon. Effectiveness of sertraline would widen the treatment modality against pathological laughing.

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“…Lesions confined to the cerebellum [37][38][39], to the basis pontis, a relay center to the cerebellum [40][41][42], or to the thalamus, an output node from the cerebellum [43], have been sufficient to produce PBA symptoms without any other known brain pathology. Indeed, in a recent detailed review of the available neuroanatomical evidence for localization of PBA [30], the basis pontis, a convergence point for descending pathways carrying cerebellar input, "stands out as the only identified site where a discrete lesion can cause [PBA]."…”

Section: Cerebellar Mechanismsmentioning

confidence: 99%

“…Dextromethorphan binding is most prominent in the brainstem and cerebellum [66], brain areas known to be rich in s-1 receptors [67] and key sites implicated in the pathophysiology of PBA [37][38][39][40][41][42]. Evidence from an ERP study also suggests glutamatergic modulation at the cortical level [36].…”

Section: Dextromethorphan/quinidinementioning

confidence: 99%

Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments

Miller¹,

Pratt

Schiffer³

2011

Expert Review of Neurotherapeutics

120

133

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Pathological Laughter as an Unusual Manifestation of Acute Stroke

Cited by 14 publications

References 15 publications

Early Marked Behavioral Symptoms in Bilateral Posterior Cerebral Artery Stroke: A Disguised Presentation

Early Marked Behavioral Symptoms in Bilateral Posterior Cerebral Artery Stroke: A Disguised Presentation

Effective Use of Sertraline for Pathological Laughing after Severe Vasospasm Due to Aneurysmal Subarachnoid Hemorrhage: Case Report

Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments

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