Apart from vague pain over the right side of face in Vl-V2 division, his entire neurological examination had been normal. A follow up visit 7years after surgery showed no recurrence of abnormal laughter and crying.
The long term follow up MRI scan did not reveal any residual lesion in the right cerebellopontine angle or in the region of Meckel's cave. The left facial weakness improved completely in 7 days but the impaired pin-prick over right Vl-V2 division remained. The postoperative recovery was uneventful, with complete resolution of unprovoked laughter and crying spells on the same day. Histological examination, confirmed trigeminal schwannoma. He was operated in November 1992, under general anaesthesia and a right retromastoid supracerebellar approach was employed to excise the tumour. In view of the neurological findings and MRI scan, a trigeminal nerve tumour was suspected.
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Cerebellum and cerebral hemisphere were free of lesion. Superior portion of the 4th ventricle was also compressed. There was marked displacement of the pontomesencephalic structures and aqueduct. Seventh and eighth nerve complex was spared. A fluid-debris level was also seen within it, suggestive of cystic/necrotic changes. Tumour was hypointense on T1WI and revealed two hyperintense specks represented as fat within the tumour. MRI brain showed a fairly large to oval, predominantly cystic, peripherally enhancing (with Gadolinium-DTPA) space occupying lesion measuring 3.7x3.2x2.4 cms in size, in the right cerebellopontine angle region, anteriorly seen extending into the middle cranial fossa in the posterior parasellar region and Meckel's cave on the right side. Results of standard laboratory tests and chest X-ray were normal. There was no impairment of consciousness during these attacks. The patient could not stop these episodes and there was nothing funny either in his mind or in the enviornment. He was getting brief spells of sudden onset laughter and crying. There were no cerebellar signs, long tract signs or cranial nerve deficit. Eye movements were normal but coarse nystagmus was present on looking to the right. The left hand showed finger nose ataxia and moderate dysdiadochokinesia. There was left facial lower motor neuron weakness, with impaired pinprick over right V1-V2 division. On examination, there was no evidence of a generalised emotional or intellectual disturbances. The medical, neurological and psychiatric histories were otherwise unremarkable. The patient was aware that his labile emotion was not normal and had once sought psychiatric help. A case of trigeminal schwannoma presenting with pathological laughter in combination with crying is reported and relevant literature reviewed.Ī 46 year old right-handed man presented with spontaneous uncontrollable laughter with inappropriate crying, giddiness, weakness of left side of face and ataxia of left hand of 8 months duration. Pathophysiology of pathological laughter and crying can, at present, only be explained by a pathoanatomical stand point. Though cases of pathological laughter and crying have been documented in the literature, their diffuse nature precludes useful topographic analysis and clinicoanatomical correlation. The absence of coexisting emotional changes always signify a pathological substrate in the brain, either diffuse or focal. Forced laughing and crying is a rare neurological symptom with a specific differential diagnosis. Laughing and crying are termed pathological when the behaviour is continuous and inappropriate. Trigeminal schwannoma associated with pathological laughter and crying.
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How to cite this URL: Virani M J, Jain S. How to cite this article: Virani M J, Jain S.
Theories of mechanism of pathological laughter and crying reported in the literature are reviewed. No recurrence of laughter and crying attacks were noted after total removal of the tumour. The tumour developed in the cerebellopontine angle, compressing the pontomesencephalic structures backward, extending in the posterior parasellar region and Meckel's cave. Trigeminal schwannoma associated with pathological laughter and crying.ĭepartment of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, 400 026, India.Ī 46 year old man with trigeminal schwannoma displayed symptoms of ataxia with pathological laughter and crying.
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