Abstract
Laughter is considered pathologic when involuntary and inappropriate. Pathologic laughter may be seen in many neurologic disorders, including gelastic epilepsy, posterior fossa space-occupying lesions, demyelinating diseases, and pontine or hemispheric infarcts (bulbar and pseudobulbar palsy).1 We report a patient with pathologic laughter occurring prominently on swallowing, associated with basilar artery dissection and pseudoaneurysm. A 33-year-old man with a history of atrial fibrillation was admitted after two episodes of dizziness, diplopia, dysarthria, ataxia, left hemiparesis, and circumoral numbness. MRI showed bilateral pontine infarctions. MR angiography (MRA) revealed a dolichoectatic basilar artery, with partial thrombosis anterior to the left pons. Angiography demonstrated basilar artery dissection. He was discharged on warfarin. Symptoms improved over 3 months. Two months later, during a funeral, he first experienced involuntary, inappropriate laughter. Episodes of laughter continued, 10 times daily, lasting 1 minute. Swallowing liquids, but not solids, routinely triggered laughter. Other triggers included unfamiliar situations (being in a hospital or public place) and …
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