Pathological laughter as an early and unusual presenting symptom of petroclival meningioma: A case report and review of literature.

Pathological laughter as an early and unusual presenting symptom of petroclival meningioma: A case report and review of literature.

World Neurosurg. 2018 Dec 13;:

Authors: Gosal JS, Pandey S, Das KK, Khatri D, Rangari K, Jaiswal AK, Behari S

Abstract
BACKGROUND: Pathological laughter is inappropriate, involuntary and unmotivated laughter episodes which may or may not be associated with mirth or amusement. Though associated with many diffuse brain pathologies, its association with intracranial focal mass lesions causing ventrolateral brainstem compression like petroclival meningioma is very rare. The exact pathophysiology of this interesting and unusual clinical symptom is unknown but probably involves disinhibition and release of the so-called coordination center located in the upper brainstem due to compression by the tumor.
CASE DESCRIPTION: A 26-year-old lady presented with recurrent episodes of inappropriate and involuntary laughter which significantly affected her quality of life for two years. These episodes did not resolve, and a magnetic resonance imaging (MRI) of the brain showed a giant petroclival meningioma causing upper brainstem compression. Near total excision of the tumor was done using an extended middle fossa approach. To our surprise, the pathological laughter subsided immediately after surgery.
CONCLUSION: Pathological laughter may be the only symptom of a focal mass lesion causing ventrolateral upper brainstem compression like petroclival meningioma well before other neurological sign/symptoms appear. Tumors causing ventral brainstem compression must be ruled out before the patient is sent for a psychiatric evaluation.

PMID: 30554003 [PubMed - as supplied by publisher]

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