Persistent pseudobulbar affect secondary to acute disseminated encephalomyelitis

Abstract

Pseudobulbar affect (PBA) is a common complication of central nervous system diseases such as stroke, multiple sclerosis, and other neurological diseases, but it remains under-recognized and under-treated in the clinic. PBA caused by acute disseminated encephalomyelitis (ADEM) has rarely been reported. Here, we report a 30-year-old Chinese woman who has experienced PBA from ADEM for 7 years. The patient's principal manifestations were extreme emotions or tears when she saw, heard, or spoke about sad news or other sad things; the durations of these unmanageable emotions were often less than 30 sec, and they occurred at frequencies that ranged from one to several times a day. Occasionally, she laughed uncontrollably while people were talking despite a lack of funny or sad stimuli in the conversation or the surrounding environment. Thus, her social functioning was impaired. This case indicates that the long-term PBA can occur secondarily to ADEM, and this possibility should be considered clinically to ensure timely identification and treatment.

The spectrum of involuntary vocalizations in humans: A video atlas

“…However, pathological laughter and crying is most commonly associated with neurodegenerative disorders, such as ALS, 163 FTD, 164 Alzheimer's disease, 165 primary progressive aphasia, 166 multiple system atrophy cerebellar type, 167 CJD, 168 spinocerebellar ataxia (SCA) 17, 169 and HD. Focal brain lesions in cerebrovascular disease, [170][171][172][173][174][175][176][177] traumatic brain injury, [178][179][180] autoimmune-mediated lesions in disseminated encephalomyelitis [181][182][183] or drug-induced behavior 184 are additional etiologies. Finally, recurring "automatic" laughter was also reported as part of ictal phenomena (gelastic seizures).…”

Recognizing and treating pseudobulbar affect

“…9 A 2015 case report described persistent PBA following acute disseminated encephalomyelitis, a rare inflammatory demyelinating disorder. 10 These and other published studies and case reports illustrate that disruption of cortico-pontine-cerebellar tracts can occur by a variety of mechanisms, including toxic effects (consider chemotherapy or substance abuse), acute inflammatory syndromes, traumatic brain injury ranging from mild to severe, tumors, aneurysm, stroke, and surgery just to name a few. These facts should encourage any practitioner to expand the categories of illness that they think may be an underlying cause of PBA.…”

“…A 2015 case report described persistent PBA following acute disseminated encephalomyelitis, a rare inflammatory demyelinating disorder 10 …”