Prentice David, Dharsono Ferry, Martinet Patricia
Neurosciences, Perron Institute for Neurological and Translational Science, Nedlands, AUS.
Neuroradiology, Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, AUS.
Cureus. 2024 Jun 29;16(6):e63461. doi: 10.7759/cureus.63461. eCollection 2024 Jun.
A 42-year-old woman presented to the emergency department with sudden-onset uncontrollable laughter, 'fou rire prodromique' (prodrome of crazy laughter), and left leg weakness. Imaging revealed a right cerebral haemorrhage of the premotor cortex corresponding to the leg cortical representation. A history of excess phenylephrine use for sinusitis and migraine was subsequently obtained. The patient's neurological recovery was good, enabling a return to her pre-stroke employment. The neurological causes of pathological laughter and the brain networks involved are discussed in this report. The role of sympathomimetics in the causation of cerebral haemorrhage potentially via the initiation of a reversible cerebral vasoconstriction syndrome is highlighted. The use of over-the-counter substances should be part of medication history in such cases.
一名42岁女性因突发无法控制的大笑、“前驱性狂笑”（疯狂大笑的前驱症状）及左腿无力而就诊于急诊科。影像学检查显示，与腿部皮质代表区相对应的运动前皮质右侧脑出血。随后了解到患者有因鼻窦炎和偏头痛过量使用去氧肾上腺素的病史。患者神经功能恢复良好，能够重返中风前的工作岗位。本报告讨论了病理性大笑的神经学病因及相关脑网络。强调了拟交感神经药可能通过引发可逆性脑血管收缩综合征导致脑出血的作用。在此类病例中，非处方药物的使用情况应作为用药史的一部分。
