Derex L, Ostrowsky K, Nighoghossian N, Trouillas P
Service d'Urgences Neurovasculaires, Hôpital Neurologique, Lyon, France.
Stroke. 1997 Jul;28(7):1464-6. doi: 10.1161/01.str.28.7.1464.
There is increasing evidence that serotonergic neurotransmission may be damaged in poststroke pathological crying. A correlation between the clinical severity of pathological crying and the size of stroke-induced serotonergic pathway lesions is commonly accepted. We present a case of severe pathological crying after a limited left anterior choroidal artery territory infarction.
A right-handed 55-year-old man who was a heavy smoker was admitted to the hospital after a right hemiplegia of sudden onset. Clinical examination revealed a right global hemiplegia including the face and a right hemihypoesthesia. Cerebral CT scan and MRI showed an infarct in the retrolenticular part of the posterior limb of the left internal capsule extending upward into the posterior paraventricular corona radiata region. Transesophageal echocardiography revealed an atrial septal aneurysm of 15-mm excursion without associated patent foramen ovale. From the first day of admission, the patient exhibited very frequent and intense fits of pathological crying. Their persistence led to initiation of treatment with the selective serotonin reuptake inhibitor paroxetine on day 30. Complete and immediate resolution of pathological crying occurred 24 hours after onset of therapy. Follow-up examination at day 90 confirmed the absence of relapse of pathological crying.
We conclude that poststroke pathological crying in our patient may have been due to unilateral disruption of the capsular ascending projections of the serotonergic brain stem raphe nuclei. A small left-sided capsular lesion may have led to severe pathological crying. This disabling condition may be reversible with selective serotonin reuptake inhibitor therapy.
越来越多的证据表明，血清素能神经传递在中风后病理性哭泣中可能受损。病理性哭泣的临床严重程度与中风引起的血清素能通路病变大小之间的相关性已被普遍接受。我们报告一例左侧脉络膜前动脉有限区域梗死术后出现严重病理性哭泣的病例。
一名55岁右利手男性，重度吸烟者，突发右侧偏瘫后入院。临床检查发现右侧包括面部的完全性偏瘫及右侧半身感觉减退。脑部CT扫描和MRI显示左侧内囊后肢晶状体后部分梗死，向上延伸至室旁后放射冠区。经食管超声心动图显示房间隔瘤，偏移15毫米，无相关卵圆孔未闭。从入院第一天起，患者就表现出非常频繁且强烈的病理性哭泣发作。由于发作持续，在第30天开始用选择性5-羟色胺再摄取抑制剂帕罗西汀治疗。治疗开始24小时后病理性哭泣完全且立即缓解。第90天的随访检查证实病理性哭泣未复发。
我们得出结论，该患者中风后的病理性哭泣可能是由于血清素能脑干中缝核的囊状上升投射单侧中断所致。左侧小的囊状病变可能导致严重的病理性哭泣。这种致残状况可能通过选择性5-羟色胺再摄取抑制剂治疗得以逆转。
