Clinical Features and Related Factors of Poststroke Pathological Laughing and Crying: A Case–Control Study

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 3; pp. 556 - 564
• Main Authors: Wang, Geying, MD, Teng, Fei, PhD, MD, Chen, Yuhui, MD, Liu, Yuanhua, MD, Li, Yancheng, MD, Cai, Li, MD, Zhang, Xu, MD, Nie, Zhiyu, MD, Jin, Lingjing, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Aged; anger proneness; Cardiovascular; Case-Control Studies; Cognition Disorders - etiology; Crying; Female; Follow-Up Studies; Humans; Laughter; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; mild cognitive impairment; Neurology; Pathological laughing and crying; Pons - diagnostic imaging; Pons - pathology; pseudobulbar palsy; Pseudobulbar Palsy - complications; Retrospective Studies; Severity of Illness Index; Social Behavior Disorders - diagnostic imaging; Social Behavior Disorders - etiology; stroke; Stroke - complications; pseudobulbar palsy; mild cognitive impairment; Pathological laughing and crying; stroke; anger proneness
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.003

Objectives The purpose of this study was to analyze clinical features and related factors of poststroke pathological laughing and crying (PSPLC) and to differentiate PSPLC patients with and without pseudobulbar signs. Methods We performed a case–control study in which 56 patients with PSPLC were matched to 56 control stroke patients by age and gender. The pathological laughing and crying scale was used to identify patients with PSPLC. Characteristics of PSPLC outbursts, presence of pseudobulbar signs and autonomic symptoms, lesion locations, and different clinical data were analyzed. Mild cognitive impairment (MCI) was evaluated by the Montreal Cognitive Assessment. Poststroke anger proneness (PSAP) was evaluated by comparison of the patients' premorbid states. Results Significantly more patients in the PSPLC group showed MCI, PSAP, and pseudobulbar signs than those in the control group. Most patients with PSPLC showed bilateral multiple lesions and the pons (especially the bilateral paramedian basal and basal–tegmental areas) stood out as the most important lesion location. Logistic regression analysis showed that pontine lesion, MCI, and PSAP were independently related to PSPLC; however, the presence of pseudobulbar signs was not related. PSPLC patients with pseudobulbar signs showed more recurrent strokes in the previous 2 years, more severe neurological deficits, as well as higher severity of PSPLC. In addition, more patients in the group with pseudobulbar signs showed concomitant autonomic symptoms. Conclusions PSPLC, MCI, and PSAP could be manifestations of a more general disorder, in which pontine lesion plays an important role. PSPLC patients with pseudobulbar signs and those without show different features.