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Pathological laughter in trigeminal schwannoma: case report and review of the literature

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Abstract

Pathological laughter is an uncommon manifestation of neurosurgical diseases. Very few cases of trigeminal schwannoma have been reported in the literature presenting with pathological laughter as a predominant symptom. We are reporting on a case of multi-compartmental trigeminal schwannoma presenting as pathological laughter and discuss a review of the literature. A 23-year-old lady presented with pathological laughter, along with symptoms pertaining to other cranial nerves and cerebellar dysfunction. Magnetic resonance imaging (MRI) of the brain was suggestive of a dumbbell-shaped mass in the middle and posterior cranial fossa on the left side, causing significant compression of the pons. She was investigated and operated for multi-compartmental trigeminal schwannoma. Following surgery, abnormal laughter disappeared immediately and no recurrence of symptoms was -present for a follow-up of 16 months. This case supports the role of the brainstem, especially the pons, in the control of laughter and, perhaps, of the medial temporal lobe too.

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Authors and Affiliations

  1. Department of Neurosurgery, G.B. Pant Hospital and Associated Maulana Azad Medical College, New Delhi, 110002, India

    Anita Jagetia, N. Pratap Kumar, Daljit Singh & Sanjiv Sinha

  2. J71, Vijayalakshmi Apptts., I.P. Extension, Patparganj, New Delhi, 110052, India

    Anita Jagetia

Authors
  1. Anita Jagetia
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  2. N. Pratap Kumar
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  3. Daljit Singh
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  4. Sanjiv Sinha
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Correspondence to Anita Jagetia.

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Comments

Dattatraya Muzumdar, Mumbai, India

Although pathological laughter (PL) is well documented in the literature, it is still poorly understood. Jagetia et al. have reported a case of a trigeminal schwannoma presenting with PL, which disappeared immediately following surgery. This suggests that there is a definite role of severe compression of the pons and the medial temporal lobe. They have discussed the pathogenesis of PL in detail and also emphasized the recently described role of the cerebellum in the modulation of laughter and crying. Although laughing, together with crying and yawning, is a recognized pontomedullary reflex activity, the effects of a severely compressed temporal lobe and the activation of other structures involved in the important crossway of emotional mechanisms cannot be undermined. The anatomic localization of lesions that produce PL invariably involves motor pathways, and is located between the thalamus and the medulla. Various other pathologies, including meningiomas, chordomas, acoustic neuroma, and trochlear neuroma, in that region are known to present with PL. Complete excision of tumors in that region has resulted in immediate and permanent cessation of PL, thus, emphasizing the role of optimal surgery. The most common medical conditions leading to PL are: amyotropic lateral sclerosis, lacunar infarctions, diffuse hypoxic/hypotensive encephalopathies, and multiple sclerosis. However, the resolution of PL in these conditions is not as dramatic and complete as observed in tumor cases.

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Jagetia, A., Pratap Kumar, N., Singh, D. et al. Pathological laughter in trigeminal schwannoma: case report and review of the literature. Neurosurg Rev 29, 348–352 (2006). https://doi.org/10.1007/s10143-006-0038-4

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  • DOI: https://doi.org/10.1007/s10143-006-0038-4

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