Abstract Details

Title "Fou Rire Prodromique" as the Presentation of a Left Frontal Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 040

Objective

Background BACKGROUND: Pathological laughter is an exaggerated and inappropriate laughter usually unrelated to a true emotion or a congruent mood. "Fou rire prodromique" is a form of prodromal pathological laughter of uncertain pathophysiology that heralds an ischemic neurologic deficit.

Design/Methods DESIGN/METHODS: We present the case of a 33 year old woman, 6 days post c-section, with no other medical conditions, who presented with a sudden laughter attack and "confusion". Her husband described the event as "she was laughing like she was in a comedy club". Minutes after onset of the symptoms, she developed right upper extremity weakness and stopped talking. On admission, she was intermittently following some simple commands and was unable to repeat, write or read. During the evaluation her behavior was inappropriate, she was intermittently smiling with no clear trigger. She also had a mild right facial droop and a mild right arm weakness evidenced by a pronator drift. Alteplase was held due to the recent surgery and current vaginal bleeding.

Results RESULTS: Brain CT was normal, but brain MRI showed an acute ischemic infarct with petechial hemorrhage compromising the posterior left frontal lobe (Broca's area). The hypercoagulable work up was negative except for slightly low protein S activity. Brain MRA and carotid ultrasound were normal but echocardiogram with bubble study showed a small patent foramen ovale. Subsequent lower extremity doppler ultrasound and MRV pelvis ruled out deep venous thrombosis. With physical and speech therapy the patient improved.

Conclusions CONCLUSIONS: Frontal lobe involvement affecting the Broca's area, as we described in our case, has only been described once. We conclude that the patient's laughter attack was the initial manifestation of the stroke suggesting that an acute infarct of Broca's area is capable of producing this unusual clinical presentation.

Authors/Disclosures
Nancy D. Rosales, MD (Wake Forest Baptist Health) PRESENTER	No disclosure on file
Camilo I. Garcia-Gracia, MD	Dr. Garcia-Gracia has received personal compensation for serving as an employee of jazz pharmaceutical. Dr. Garcia-Gracia has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Jazz pharmaceutical.
Efrain D. Salgado, MD (Cleveland Clinic Florida)	Dr. Salgado has nothing to disclose.
Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook)	Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Cleveland Clinic.

��ɫ��

��ɫ��