A Case of Angioblastic Meningioma with Pathological Laughter

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  • 笑い発作を主訴とした髄膜腫の一例
  • —With Special Reference to Laughter in Brain Tumor—

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A 65 years-old man was admitted as a case of brain tumor. Eight months prior to admission he started paroxysmal uncontrollable laughing, and one month later, he developed a left hemiparesis with headache. Upon admission, slight choked disk and left hemiparesis were noted. Deep tendon reflexes were a little brisker on the left than on the right, but no pathological reflexes were present.<BR> The most striking symptom was occasional uncontrollable laughing without any recognizable reason. Duration of each episode was less than 20 seconds and the attack occured as often as 6-7 times a day. While laughing, neither vascular flushing of the face nor convulsion was noticed. During the attack, he did not seem to feel any emotion appropriate to laughter (Fig. 1).<BR> EEG showed polymorphic delta waves in the right fronto-centro-parietal regions and no definite epileptic patterns, even at the time of attack (Fig. 2). A right carotid angiogram revealed a localized tumor staining in the posterior frontal region (Fig. 4). The tumor was totally removed, and was confirmed histologically as angioblastic meningioma (Fig. 5). There has been no episode of laughing during the past two years after surgery.<BR> From the literature relating to the anatomy and physiology of the thalamus, hypothalamus, their cortical connections and their relationships with the limbic structure of the temporal lobe, we discussed the central mechanism of disordered laughter resulting from focal cerebral lesions, such as brain tumor, and we may say such lesions at various levels cause pathological laughing.

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