Pathological Laughter Prodromal to a Stroke of the Head of the Left Caudate Nucleus

A 38-year-old right-handed female with a past history of intermittent painful rash, dizzy spells, and chronic daily headaches as well as episodic migraines experienced an episode of transient involuntary pathological laughter, right arm weakness, and expressive dysphasia. She was found on MRI to have multiple strokes in multiple vascular distributions, including one in the head of the left caudate. A cardiac ECHO found an atrial myxoma, with extensive evaluation for other causes of stroke unrevealing. The differential diagnosis for pathological laughter in this patient is discussed. The most plausible cause in this patient is an infarct to the head of the left caudate nucleus caused by an embolus of the atrial myxoma.

Prevalence and Factors Related to Pathological Laughter and Crying in Patients With Amyotrophic Lateral Sclerosis

Objective: This study aimed to explore the prevalence and clinical correlates of pathological laughter and crying (PLC) in patients with amyotrophic lateral sclerosis (ALS).Methods: A total of 1,031 ALS patients were enrolled between August 2012 and August 2019. The PLC was recorded by a face-to-face interview. Other characteristics of patients, including depression, anxiety, cognition, and behavior function, were also evaluated. The potential associated factors of PLC were explored using forward binary regression analysis. Survival was analyzed in groups using propensity score matching (PSM) and Cox proportional hazards models.Results: The prevalence of PLC was 11.4% in all patients at baseline. Bulbar-onset and female patients had higher prevalence of PLC. The multivariate regression analysis indicated that PLC in ALS was associated with bulbar onset (p < 0.001), late disease stage (p < 0.001), and higher score in the Hamilton Depression Rating Scale (HDRS) (p = 0.012). The higher score of HDRS was significantly and independently associated with PLC occurrence in bulbar-onset patients (p = 0.032). The late disease stage was related to PLC occurrence in spinal-onset patients (p < 0.001). After comparison with matched pairs by using PSM, PLC at baseline had no impact on survival.Conclusion: PLC was not uncommon in ALS, especially in bulbar-onset and female patients. We highlighted that the emotional state other than cognitive function had possible relationship with PLC in ALS.

Brainstem Correlates of Pathological Laughter and Crying Frequency in ALS

Pseudobulbar affect is a disorder of emotional expression commonly observed in amyotrophic lateral sclerosis (ALS), presenting as episodes of involuntary laughter, or crying. The objective of the current study was to determine the association between frequency of pathological laughter and crying (PLC) episodes with clinical features, cognitive impairment, and brainstem pathology. Thirty-five sporadic ALS patients underwent neuropsychological assessment, with a subset also undergoing brain imaging. The Center for Neurological Study Lability Scale (CNS-LS) was used to screen for presence and severity of pseudobulbar affect (CNS-LS ≥ 13) and frequency of PLC episodes. Presence of pseudobulbar affect was significantly higher in bulbar onset ALS (p = 0.02). Frequency of PLC episodes was differentially associated with cognitive performance and brainstem integrity. Notably pathological laughter frequency, but not crying, showed a significant positive association with executive dysfunction on the Trail Making Test B-A (R2 = 0.14, p = 0.04). Similarly, only pathological laughter frequency demonstrated a significant negative correlation with gray matter volume of the brainstem (R2 = 0.46, p < 0.01), and mean fractional anisotropy of the superior cerebellar peduncles (left: R2 = 0.44, p < 0.01; right: R2 = 0.44, p < 0.01). Hierarchical regression indicated brainstem imaging in combination with site of symptom onset explained 73% of the variance in pathological laughter frequency in ALS. The current findings suggest emotional lability is underpinned by degeneration across distinct neural circuits, with brainstem integrity critical in the emergence of pathological laughter.

Post stroke psychiatric syndrome: a clinical study

Background: Various psychiatric symptoms are seen after strokes which are usually deserted due to poor familiarity about it, hence better knowledge and understanding of various post stroke psychiatric manifestations may help in early identification and management of it. The aim of present research is to study the demographic and clinical profile of various post stroke psychiatric manifestations.Methods: The study was conducted on ninety patients developing psychiatric symptoms after stroke. Detailed socio-demographic characteristics, clinical profile along with psychiatric assessment were recorded in proforma specially designed for the study.Results: Bulk of this post- stroke psychiatric subjects (45%) was in the age range of 61-80 years of which male and female were 29% and 16% respectively. Most of patients (90%) were residing at rural areas. 47.8 % patients were belonging to lower middle socio-economic status. Majority of subjects (42.8%) were unemployed followed by farmer and skilled worker (20% each), and most of the patients were right handed (97.8%). On clinical parameters maximum subjects (52.2) developed post stroke major depression followed by depression mixed with anxiety (16.6%). Rest of patients suffered from organic anxiety disorder (8.8%), vascular dementia (10%), amnestic syndrome (5.5%), post stroke psychosis (3.3%), organic manic disorder (2.2%), pathological laughter and crying (1.1%).Conclusions: Huge number of patients (52.9%) developed psychiatric problems of diverse nature among patients with stroke syndrome. depression was most common post stroke psychiatric manifestation, followed by mixed anxiety with depression. Generally the post stroke psychiatric manifestations are unrecognized and untreated, which has adverse impact on process of stroke rehabilitation. Thus a detailed psychiatric evaluation is mandatory in all patients of stroke syndrome to rule out psychiatric illness.

Transient mutism, pathological laughter and cerebellar ataxia after primary varicella-zoster virus infection

Acute postinfectious cerebellitis is characterised by inflammatory involvement of the cerebellum and consequent cerebellar dysfunction, usually presenting a benign and self-limited course. Common symptoms described in the literature include ataxia, peripheral facial paralysis, aphasia, spinal dysfunction and eventually hydrocephalus. We describe a rare presentation of acute cerebellitis after varicella, in a 6-year-old child, who presented with ataxia, dysmetria, mutism and pathological laughter.