[Gelastic seizures as the presenting symptom of infarction of the cingulate gyrus]

Gelastic seizures are infrequent epileptic seizures in which the main manifestation is inappropriate laughter. They have a variety of causations. A search of the literature did not reveal any cases of pathological laughter that was clearly related with strokes, although there a numerous reports of non-epileptic pathological laughter as a prodromal symptom in stroke patients (fou rire prodromique). We report the case of a patient with infarcted cingulate gyrus who progressed with gelastic seizures at onset and during the course of the clinical process.

An 81-year-old female who suddenly presented bouts of difficulties in verbal expression with disconnection from the milieu that were accompanied by fits of unmotivated and uncontrollable laughter that lasted less than five minutes. Following the attacks, her level of consciousness had dropped. In some of the attacks there were also involuntary movements of the upper limbs. Resonance imaging revealed the existence of an acute ischaemic lesion in the left territory of the cingulate gyrus and an electroencephalogram revealed the existence of epileptogenic activity in the left-hand anterior temporal and frontal regions.

The clinical profile, the results of the complementary examinations and the response to the antiepileptic treatment allow us to state that in the episode reported in this patient we are dealing with gelastic seizures related to an acute ischaemic lesion in the left cingulate gyrus.