Awada A, Halaby G, Tamraz J
Service de neurologie, Hôtel-Dieu de France, Achrafieh, Beyrouth, Liban.
Rev Neurol (Paris). 2009 Jan;165(1):86-8. doi: 10.1016/j.neurol.2007.10.011. Epub 2008 Jun 26.
Spasmodic laughter is a classical sign of pseudobulbar palsy, but it has never been reported, to our knowledge, to provoke syncope.
A 63-year-old hypertensive and diabetic man with peripheral neuropathy and lacunar pseudobulbar palsy presented with three episodes of spasmodic laughter which had induced syncope. No new episode was observed after the beginning of low dose bisoprolol.
Sustained or spasmodic laughter is accompanied by repetitive bursts of forced expiration, corresponding to short repetitive Valsalva maneuvers. Laughter-induced syncope is considered as one of the many Valsalva-type/vagally mediated syncopal attacks leading to rapid fall in blood pressure without compensatory tachycardia. The presence of autonomic diabetic neuropathy may also contribute to these attacks.
痉挛性笑声是假性延髓麻痹的典型体征，但据我们所知，从未有过其引发晕厥的报道。
一名63岁患有高血压、糖尿病、周围神经病变和腔隙性假性延髓麻痹的男性出现了三次痉挛性笑声发作，并由此诱发了晕厥。开始服用小剂量比索洛尔后未再观察到新的发作。
持续性或痉挛性笑声伴有反复的用力呼气爆发，相当于短暂的反复瓦尔萨尔瓦动作。笑性晕厥被认为是众多瓦尔萨尔瓦型/迷走神经介导的晕厥发作之一，会导致血压迅速下降且无代偿性心动过速。自主神经糖尿病神经病变的存在也可能导致这些发作。
