Pathological Laughter as an Unusual Manifestation of Acute Stroke

vealed an acute infarction in the left side of the rostral basis pontis ( fig. 1 A). CT angiography showed a severe stenosis in the midbasilar artery. Nearly all of her neurological deficits had disappeared by the time she was discharged. However, she complained of general weakness, anorexia and a depressed mood. We prescribed a selective serotonin reuptake inhibitor (SSRI; citalopram 20 mg/day) in addition to the anticoagulation therapy. Two months later, she experienced sudden dizziness, dysarthria and mild difficulty swallowing. She also noted transient alternating right and left facial paresthesia. She was alert and cooperative. The reDear Sir, Poststroke pathological laughter can develop during the acute or chronic stage following cerebral infarcts. The latter delayed-onset type, commonly known as emotionalism, is usually associated with the bilateral involvement of the descending corticobulbar pathways as a component of pseudobulbar palsy [1, 2] . The former, called ‘fou rire prodromique’ by Fere in 1903 [3] , has been reported in just a few cases and is often confused with the delayed-onset form. This acute-onset type has been considered to be a unique situation rather than a symptom of acute ischemia because the spells of laughter are generally transient, often herald stroke as a single episode [4] or immediately follow the onset of focal deficits [5] . However, the clinical significance of the acute-onset type remains controversial. A recent case report suggested that the acute-onset type of pathological laughter might be a symptom of acute stroke [6] . We report a patient who experienced fluctuating pathological laughter simultaneously with neurological deficits following recurrent bilateral pontine infarcts, which supports the hypothesis that ‘the acute-onset type of pathological laughter is one of the symptoms of acute stroke’.