Temporary Forced Laughter after Unilateral Strokes

Abstract

Forced laughter generally occurs in bilateral or diffuse lesions of the brain and is generally associated with pathologic crying. We report the cases of 3 patients in whom temporary forced laughter occurred after unilateral supratentorial infarction demonstrated by CT scan or MRI. In all cases, the lesion was exclusively subcortical and involved the striatocapsular region. For all patients the laughter occurred during the revovery phase of motor deficit and was ‘pure’ without associated weeping or other clinical features of pseudobulbar palsy. In all cases, the laughter attacks had become much less frequent or had totally disappeared 1 or 2 months after the stroke. According to a ‘motor’ hypothesis, a unilateral striatocapsular lesion may lead to temporary deregulation of the expression mechanisms.

Post-stroke emotional incontinence after small lenticulocapsular stroke: correlation with lesion location

“…Previous literature has shown that lenticulocapsular strokes are frequently related to post-stroke pathological laughter/crying or EI [4,5,9,10,17].We found that as many as a half of the patients with lacune-sized, unilateral lenticulo-capsular strokes had EI on prospective examination. However, it must be pointed out that this figure does not represent the precise incidence of EI after small lenticulocapsular stroke.…”

“…For the further analysis of the lesions, the level where the thalamus is well visualized was designated as 'lower (L) level', while one or two cuts higher than this in which corona radiata are seen was designated as 'upper (U) level'. Eight patients (patients 4,6,9,10,12,13,17,24) had lesions only at 'L' level, 8 (patients 2, 3, 5, 7, 18, 20, 21, 25) had lesions only at 'U' level while nine patients (patients 1,8,11,14,15,16,19,22,23) had lesions involving both. In 'L' level, the globus pallidus is well identified by dark signal intensity ( Fig.…”

“…The prevalence of this post-stroke EI has been reported to range from 15 % to 18 % [8,12,14]. Previous studies using autopsy materials [17] and imaging studies [4,5,9,10] showed that lenticulocapsular strokes are closely related to EI or pathological emotionalism.According to Kim and ChoiKwon [10], patients with lenticulocapsular stroke more often develop EI than depression.However,there still are patients who do not develop EI, and what factors determine the occurrence of EI in the patients with lenticulocapsular stroke remains unknown. Because strokes occurring in the lenticulocapsular area are relatively common, elucidating these factors would be of interest.…”

Smile-wink phenomenon: aggravated narrowing of palpebral fissure by smiling after lenticulocapsular stroke

“…1 and 5), recent studies [6,11,12] have revealed that emotional incontinence is not infrequent in patients with unilateral lenticulocapular stroke. Therefore it is likely that the lenticulocapsular lesions of the patients are responsible for the symptoms as well.…”

Therapeutic use of dextromethorphan: Key learnings from treatment of pseudobulbar affect

“…PBA is most commonly associated with neural damage (bilateral or unilateral) to the inhibitory prefrontal cortical circuitry descending to diencephalic and brainstem structures that regulate both involuntary and voluntary faciorespiratory mechanisms: the corticohypothalamic and corticobulbar tracts [9,[25][26][27][28][29]. Although PBA has been associated with both bilateral and unilateral lesions, the expression of PBA symptoms may be differentially influenced by laterality [30][31][32][33][34].…”