Pathological Laughing As a Manifestation in a Clinically Isolated Brainstem Syndrome: A Case Report

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2008.00281.x Byline: Belgin Kocer (1), Yusuf Oner (1), Hale Batur (1), Bijen Nazliel (1), Bulent Cengiz (1), Turgut Tali (1) Keywords: Multiple sclerosis; clinically isolated syndromes; pathological laughing; pathophysiology; treatment Abstract: ABSTRACT The prevalence of pathological laughing and crying in multiple sclerosis (MS) is 10%. It has been speculated that the anatomical lesion responsible for the pathological laughing is located in the pontine base, prefrontal cortex, and cerebellum. We report an 18-year-old male patient presenting with pathological laughing and hypomania. In his neurological examination, he had a euphoric effect with ataxic walking and dysarthria speech. He had a bilateral conjugated gaze limitation, with a prominent bilateral horizontal nystagmus on left gaze, dysmetria, dysdiadokokinesia, and remarkable dysfunction in a heel-to-shin test on the left. The IgG index in cerebrospinal fluid was normal with an oligoclonal band was present. In cranial MRI, there was a lesion on central pons which was hypointense in T1 images with contrast enhancement and hyperintense in T2 and flair images. Also another lesion in right brachium pontis which did not contrast enhancement but was hyperintense on T2 and flair images was present. There was an elevation of myoinositol/creatine ratio and choline and a reduction of NAA in proton MR spectroscopy. MR spectroscopic evaluation of the patient demonstrated the demyelination process. There has been no report of patients in whom pathological laughter was the presenting symptom of clinically isolated brainstem syndrome. Author Affiliation: (1)Department of Neurology, Gazi University School of Medicine, Cankaya-Ankara, Turkey (BK, HB, BN, BC); and Department of Radiology, Gazi University School of Medicine, Cankaya-Ankara, Turkey (YO, TT). Article History: Acceptance: Received February 7, 2008, and in revised form April 20, 2008. Accepted for publication May 19, 2008. Article note: Correspondence: Address correspondence to Dr. Belgin Kocer, Sedat Simavi sokak 17/32 B Block, Cankaya-Ankara, Turkey. E-mail: ebkocer@yahoo.com.