![]() Results of standard laboratory tests and chest X-ray were normal. There was no impairment of consciousness during these attacks. The patient could not stop these episodes and there was nothing funny either in his mind or in the enviornment. He was getting brief spells of sudden onset laughter and crying. There were no cerebellar signs, long tract signs or cranial nerve deficit. Eye movements were normal but coarse nystagmus was present on looking to the right. The left hand showed finger nose ataxia and moderate dysdiadochokinesia. There was left facial lower motor neuron weakness, with impaired pinprick over right V1-V2 division. On examination, there was no evidence of a generalised emotional or intellectual disturbances. The medical, neurological and psychiatric histories were otherwise unremarkable. The patient was aware that his labile emotion was not normal and had once sought psychiatric help. A case of trigeminal schwannoma presenting with pathological laughter in combination with crying is reported and relevant literature reviewed.Ī 46 year old right-handed man presented with spontaneous uncontrollable laughter with inappropriate crying, giddiness, weakness of left side of face and ataxia of left hand of 8 months duration. Pathophysiology of pathological laughter and crying can, at present, only be explained by a pathoanatomical stand point. Though cases of pathological laughter and crying have been documented in the literature, their diffuse nature precludes useful topographic analysis and clinicoanatomical correlation. The absence of coexisting emotional changes always signify a pathological substrate in the brain, either diffuse or focal. Forced laughing and crying is a rare neurological symptom with a specific differential diagnosis. Laughing and crying are termed pathological when the behaviour is continuous and inappropriate. Trigeminal schwannoma associated with pathological laughter and crying. How to cite this URL: Virani M J, Jain S. How to cite this article: Virani M J, Jain S. Theories of mechanism of pathological laughter and crying reported in the literature are reviewed. No recurrence of laughter and crying attacks were noted after total removal of the tumour. The tumour developed in the cerebellopontine angle, compressing the pontomesencephalic structures backward, extending in the posterior parasellar region and Meckel's cave. Future studies are needed to validate it prospectively.Trigeminal schwannoma associated with pathological laughter and crying.ĭepartment of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, 400 026, India.Ī 46 year old man with trigeminal schwannoma displayed symptoms of ataxia with pathological laughter and crying. CONCLUSIONS: This novel phenomenological and pathomechanistic nomenclature explains all subtypes of DLC in neurologic, medical, and psychiatric conditions. Phenomenology changed or progressed to mixed DLC in 7 patients. Six patients had negative motor DLC, 5 had positive sensory DLC, 4 had negative sensory DLC, and 2 had positive motor DLC. Ten patients had lesions in the brainstem, 4 in the cerebral hemispheres, and 2 in sub-cortical-diencephalic structures. RESULTS: Among the patients studied, DLC resulted from ischemic stroke (n = 12), intracerebral hemorrhage (n = 2), gunshot wound (n = 1), amyotrophic lateral sclerosis (n = 1), or vestibular migraine (n = 1). The sensory subtype is represented by disorders of "feeling processing," whereas the motor subtype is represented by disorders of "emotion processing." "Positive" and "negative" describe elicitation by irritative vs destructive lesions, respectively. According to intensity and frequency of laughter and crying (observed behavioral output), patients were divided into hypoactive or hyperactive DLC and subdivided into 5 subtypes: sensory (positive and negative), motor (positive and negative), and mixed. METHODS: We present the clinical and imaging findings of 17 patients with DLC and introduce a new classification based on phenomenology and pathogenesis. N2 - BACKGROUND: Disorders of laughter and crying (DLC) are seen in several neuropsychiatric conditions. JF - Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists T1 - Pathological laughter and crying: A case series and proposal for a new classification.
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