Pathological laughter in a patient with trigeminal neurinoma

Abstract

-We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.KEY WORDS: pathological laughter, neurinoma, trigeminal neuralgia. Riso patológico em uma paciente com neurinoma de trigêmeoRESUMO -Relatamos o caso de uma paciente de 47 anos com história de longa data de ansiedade que apresentou início de dor facial em choques do lado direito e episódios de riso sem motivação. Ela não podia explicar os episódios de riso e não percebia uma sensação de graça que os precedia. Ao exame neurológico apresentava paresia do VI nervo e hipoestesia no trajeto dos ramos oftálmico e maxilar do trigêmeo. A ressonância magnética de encéfalo apresentava uma lesão cística na fossa média direita causando significativo efeito de massa sobre o tronco encefálico. Um acesso combinado fronto-orbito-zigomático e pré-temporal foi realizado e a exploração intra e extra-dural revelou um grande tumor no nervo trigêmeo. Toda a lesão foi ressecada, revelando ser um neurinoma no exame patológico. A paciente manteve a paresia de VI nervo mas apresentou remissão completa dos episódios de riso imotivado durante o seguimento de um ano. PALAVRAS-CHAVE: riso patológico, neurinoma, neuralgia trigeminal.

Giant clival chordoma causing pathological laughter

“…[2] Trigeminal neuroma was also the cause of the unmotivated laughing of the patient reported by Machado. [7]…”

Sleep-laughing – Hypnogely

“…These patients on occasion exhibit non-provoked laughing, in rare cases confined only to the sleep period. Such laughter is usually paroxysmal, unmotivated, devoid of emotional component and lacking diurnal pattern [19][20][21][22][23][24][25][26] . Sleep dissociation and loss of REM atonia reported in a patient with clival chordoma who exhibited pathological laughter exclusively during sleep suggest the role for the locus coeruleus and other pontine structures 22 .…”

The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration

“…The occurrence of PBA has been reported in a multitude of neurologic illnesses including, but not limited to, ALS, [15][16][17][18][19] PD and other movement disorders, 13,[20][21][22] MS, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] stroke, [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] various types of dementia and other neurodegenerative disorders, 55-62 traumatic brain injury (TBI), 63-66 central nervous system tumors, [67][68][69][70][71][72][73][74]...…”