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Pathological Laughing and Crying following Midbrain Infarction: Case Report and Literature Review

중뇌 경색 이후 발생한 병적 웃음과 울음 환자: 증례 보고 및 문헌 고찰

  • Received : 2018.09.15
  • Accepted : 2018.10.01
  • Published : 2018.10.31

Abstract

Pathological laughing and crying (PLC) is a condition defined by relatively uncontrollable episodes of laughter, crying or both. PLC is an uncommon symptom usually caused by cerebral lesions. Midbrain involvement causing PLC is extremely unusual and the exact mechanism by which this condition develops is poorly understood. We recently experienced a 51-year-old woman who were diagnosed as PLC after midbrain infarction. She was treated by acupuncture, pulsed electromagnetic therapy (PEMT). After 6 weeks treatment, Pathological Laughter and Crying Scale (PLACS), Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) are decreased and Korean version of Modified Barthel Index (K-MBI) is increased. Treatment of traditional Korean Medicine could be effective for stoke rehabilitation including post-stroke PLC. And we have considered mechanism of PLC associated with midbrain lesion, dysfunction of cortex-thalamus-hypothalamus-basal ganglia-mesencephalon and faciorespiratory nuclei pathways, cerebro-ponto-cerebellar pathways and damaged serotonergic neurotransmission can cause this based on recent neurobiology of emotion. To define exact mechanism and find effective treatment, further studies are needed.

Keywords

Pathological laughing and crying;Midbrain infraction;Acupuncture;Pulsed electromagnetic therapy

References

  1. Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychatry. 1993;150(2):286-93. https://doi.org/10.1176/ajp.150.2.286
  2. Kim BR, Lee JY, Kim MJ, Jung HJ, Lee JM. Korean version of the Scale for the Assessment and Rating of Ataxia in ataxic stroke patients. Ann Rehabil Med. 2014;38(6):742-51. https://doi.org/10.5535/arm.2014.38.6.742
  3. Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ, Kim SH, Kim TH, Han TR. Development of the Korean version of Modified Bathel Index (K-MBI): multi-center study for subjects with stroke. J Korean Acad Rehab Med. 2007;31(3):283-97.
  4. Morris EB, Phillips NS, Laningham FH, Patay Z, Gajjar A, Wallace D, Boop F, Sanford R, Ness KK, Ogg RJ. Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. Brain. 2009;132(11):3087-95. https://doi.org/10.1093/brain/awp241
  5. Finkelstein Y, Zhang N, Fitsanakis VA, Avison MJ, Gore JC, Aschner M. Differential deposition of manganese in the rat brain following subchronic exposure to manganese: a T1-weighted magnetic resonance imaging study. Isr Med Assoc J. 2008;10(11):793-8.
  6. Cao Z, Lv J, Ding Z, Du H. Pathological laughter in a patient with Rathke cleft cyst. J Clin Neurosci. 2008;15(11):1279-82. https://doi.org/10.1016/j.jocn.2007.08.030
  7. Murai T, Barthel H, Berrouschot J, Sorger D, von Cramon DY, Muller U. Neuroimaging of serotonin transporters in post-stroke pathological crying. Psychiatry Res. 2003;123(3):207-11. https://doi.org/10.1016/S0925-4927(03)00065-9
  8. Bauer G, Gerstenbrand F, Hengl W. Involuntary motor phenomena in the locked-in syndrome. J Neurol. 1980;223(3):191-8. https://doi.org/10.1007/BF00313183
  9. Parvizi J, Anderson SW, Martin CO, Damasio H, Damasio AR. Pathological laughter and crying: a link to the cerebellum. Brain. 2011;124(9):1708-19.
  10. Morgane PJ, Galler JR, Mokler DJ. A review of systems and networks of the limbic forebrain/limbic midbrain. Progress in Neurobiology. 2005;75(2):143-60. https://doi.org/10.1016/j.pneurobio.2005.01.001
  11. Lee WT, Park KA. Medical Neuroanatomy. 2nd ed. Seoul:Korea Medical Book Publisher. 2008:375,544.
  12. Kin HS, Moon SG, Park SU, Han CH. Integrated clinical approach to stroke. 2nd ed. Seoul:Jeong Dam. 2007:367-409.
  13. Zhu W, Ye Y, Liu Y, Wang XR, Shi GX, Zhang S, Liu CZ. Mechanisms of acupuncture therapy for cerebral ischemia: an evidence-based review of clinical and animal studies on cerebral ischemia. J Neuroimmune Pharmacol. 2017;12(4):575-92. https://doi.org/10.1007/s11481-017-9747-4
  14. Choi JH, Kim LH, Yun JM, Moon BS. Study of clinical research acupuncture treatment on post-stroke depression. Korean J Oriental Physiology and Pathology. 2011;25(6):1119-28.
  15. Xie Z, Cui F, Zou Y, Bai L. Acupuncture enhances effective connectivity between cerebellum and primary sensorimotor cortex in patients with stable recovery stroke. Evid Based Complement Alternat Med. 2014;2014:1-9.
  16. Tsutsumi S, Hatashita S, Kadota Y, Abe K, Ueno H. Tentorial meningioma associated with pathological laughter-case report. Neurol Med Chir (Tokyo). 2000;40(5):272-4. https://doi.org/10.2176/nmc.40.272
  17. Keller R, Torta R, Lagget M, Crasto S, Bergamasco B. Psychiatric symptoms as late onset of Wilson's disease: neuroradiological findings, clinical features and treatment. Ital J Neurol Sci. 1999;20(1):49-54. https://doi.org/10.1007/s100720050010
  18. Kim EJ, Sim KC. The neuro-regeneration effect of peripheral nerve stimulation and rTMS in SCI induced rats. J Korean Health and Fundamental Med Sci. 2013;6(2):53-9.
  19. Cha HG, Kim MK, Nam HC, Ji SG. Effects of high frequency repetitive magnetics stimulation on function in subacute stroke patients. Journal of Magnetic. 2014;19(2):192-6. https://doi.org/10.4283/JMAG.2014.19.2.192
  20. Kim JH, Nam BW, Choi JY. Pathological laughing and crying: pathophysiology and treatment. Korean Journal of Psychosomatic Medicine. 2013;21(2):93-8.
  21. Wang GY, Teng F, Chen YH, Liu Y, Li Y, Cai L, Zhang X, Nie Z, Jin L. Clinical features and related factors of poststroke pathological laughing and crying: a case-control study. Journal of Stroke and Cerebrovascular Disease. 2016;25(3):556-64. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.003
  22. Lauterbach EC, Cummings JL, Kuppuswamy PS. Toward a more precise, clinically-infomed pathophysiology of pathological laughing and crying. Neuroscience and Biobehavioral Reviews. 2013;37(8):1893-916. https://doi.org/10.1016/j.neubiorev.2013.03.002
  23. Parvizi J, Coburn KL, Shillcutt SD, Coffey CE, Lauterbach EC, Mendez MF. Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on research. J Neuropsychiatry Clin Neurosci. 2009;21(1):75-87. https://doi.org/10.1176/jnp.2009.21.1.75
  24. Norihiro S. Technique of neurologic examination and process for localization in clinical neurology. 1st ed. Seoul:Median Books Publication. 2013:204-41.
  25. Brandstater ME, Basmajian JV. Stroke Rehabilitation. 1st ed. Philadelphia:Williams & Wilkins. 1984:318-29.
  26. Chaudhry N, Puri V, Patidar Y, Khwaja GA. Pathological laughter associated with paroxysmal kinesigenic dyskinesia: a rare presentation of acute disseminated encephalomyelitis. Epilepsy Behav Case Rep. 2013;1:14-9. https://doi.org/10.1016/j.ebcr.2012.11.001
  27. Dabby R, Watemberg N, Lampl Y, Eilam A, Rapaport A, Sadeh M. Pathological laughter as a symptom of midbrain infarction. Behav Neurol. 2004;15(3-4):73-6. https://doi.org/10.1155/2004/409248