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[Pathological crying and unilateral pontine infarction]
R de Oliveira-Souza1, W M de Figueiredo, P A Andreiuolo
1Serviço de Clínica Médica C, Hospital Universitário Gaffrée, e Guinle, UNI-RIO (HUGG-UNI-RIO), Rio de Janeiro, Brasil.
Abstract:
A 64-year-old man presented with pathologic crying and right hemiplegia due to a unilateral pontine infarct from probable branch disease of the basilar artery. The circumscribed nature of the lesion was supported by MRI and short-latency evoked potentials. The weeping spells ceased after a few days of imipramine in low doses. Pathologic laughing and crying can be viewed as a limbic-motor disconnection syndrome, in which the faciovocal motor system is released from forebrain afferents carrying information of emotional content. The inclusion of pathologic laughing and crying in the syndrome pseudobulbar palsy is inaccurate and misleading, since each is related to distinct functional and anatomic systems intrinsic to the human brainstem.
Insights
Pathologic crying, a symptom of brainstem lesions, can be treated with imipramine. This condition is a limbic-motor disconnection, not pseudobulbar palsy, due to distinct brainstem systems.
Area of Science:
- Neurology
- Neuroscience
- Neuroanatomy
Background:
- Pathologic crying and laughing are involuntary emotional expressions.
- These symptoms are often associated with neurological disorders.
- Understanding the underlying neuroanatomy is crucial for accurate diagnosis.
Observation:
- A 64-year-old man experienced pathologic crying and right hemiplegia.
- The symptoms stemmed from a unilateral pontine infarct, likely due to basilar artery branch disease.
- Magnetic Resonance Imaging (MRI) and short-latency evoked potentials confirmed a localized lesion.
Findings:
- Low-dose imipramine effectively resolved the patient's weeping spells within days.
- Pathologic laughing and crying are proposed to be a limbic-motor disconnection syndrome.
- This syndrome involves the release of the faciovocal motor system from forebrain emotional input.
Implications:
- The findings suggest distinct functional and anatomic systems for pathologic laughing and crying within the brainstem.
- Classifying these symptoms under pseudobulbar palsy is considered inaccurate and misleading.
- This research highlights the importance of precise neuroanatomical localization for understanding and treating emotional dysregulation.