Tsutsumi Satoshi, Yasumoto Yukimasa, Ito Masanori
Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Neurol Med Chir (Tokyo). 2008 Jul;48(7):307-10. doi: 10.2176/nmc.48.307.
A 60-year-old, right-handed female presented with episodes of pathological laughter and left hemiparesis. She had no history of traumatic brain injury, or neurological or psychiatric disease, and showed no signs of drug or alcohol abuse. Neurological examination found moderate left hemiparesis. Her face was symmetrical with intact emotional expression. The episodes of pathological laughter had become more frequent during the 3 months since the onset of hemiparesis, were elicited by non-specific, trivial stimuli, and lasted for a few minutes until she gained some control. Her personal and social behavior was entirely appropriate except for the outbursts of laughter. Cerebral magnetic resonance (MR) imaging revealed a 2.5 x 2.5 x 3 cm ring-enhanced mass in the subcortical area of the right frontal lobe associated with extensive perifocal brain edema. The hypothalamus, thalamus, internal capsule, brainstem, and cerebellum were unaffected. Functional MR imaging showed the tumor located mainly in the prefrontal area with the posterior limit involving the premotor cortex. She underwent total tumor resection. The histological diagnosis was glioblastoma multiforme. The pathological laughter and hemiparesis resolved within 2 weeks after surgery. Invasive tumor in the frontal lobe involving the prefrontal cortex and subcortical structure may cause pathological laughter, and can be cured by surgery.
一名60岁右利手女性出现病理性发笑和左侧偏瘫症状。她没有创伤性脑损伤史，也没有神经或精神疾病史，且没有药物或酒精滥用迹象。神经系统检查发现中度左侧偏瘫。她的面部对称，情感表达正常。自偏瘫发作以来的3个月里，病理性发笑发作愈发频繁，由非特异性的琐碎刺激引发，持续几分钟直到她能有所控制。除了发笑发作外，她的个人和社交行为完全正常。脑磁共振成像显示右额叶皮质下区域有一个2.5×2.5×3厘米的环形强化肿块，伴有广泛的瘤周脑水肿。下丘脑、丘脑、内囊、脑干和小脑未受影响。功能磁共振成像显示肿瘤主要位于前额叶区域，后界累及运动前皮质。她接受了肿瘤全切手术。组织学诊断为多形性胶质母细胞瘤。病理性发笑和偏瘫在术后2周内消失。额叶累及前额叶皮质和皮质下结构的浸润性肿瘤可能导致病理性发笑，手术可治愈。
