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(Stroke. 1998;29:1067-1068.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Fou Rire Prodromique and Ischemic Stroke

Aida Lago, MD

Servicio de Neurología, Hospital Universitari la Fe, Valencia, Spain

To the Editor:

The recent article by Carel and colleagues¹ describes an ischemic stroke preceded by a transient fit of laughter, or fou rire prodromique; they found two previous cases^{2 3} in the literature. We recently reported⁴ a case of an embolic stroke preceded by an episode of pathological laughter. The patient was a 78-year-old man with a history of atrial fibrillation and a previous ischemic stroke 20 days before, characterized by dizziness and visual disturbance. He was shopping and suddenly began to laugh; the fit of laughter lasted 15 minutes and was followed by Wernicke's aphasia and right hemiparesia. A CT scan in the emergency room showed an infarction in the posterior division of the right middle cerebral artery. In a CT control scan performed 48 hours later, a recent infarction in the posterior division of the left middle cerebral artery, sparing deep subcortical territory, was additionally shown. An EEG recording demonstrated theta-delta activity in posterior areas with no epileptic activity. Hemiparesia disappeared within 48 hours; the patient remained agitated the first days, and looked blind. Six months later the aphasia and hemianopia persisted. The fit of laughter did not recur.

Fou rire prodromique is a descriptive term for a condition whose precise mechanism is not well known. Carel and colleagues¹ found no conclusive evidence regarding the nature of the symptom, although they argued against an epileptic seizure. In our patient it is impossible to distinguish the fou rire prodromique, a descriptive expression, from a gelastic seizure as the first sign of an embolic cortical stroke.

References

1. Carel C, Albucher JF, Manelfe C, Giraud-Chaumeil B, Chollet F. Fou rire prodromique heralding a left internal carotid artery occlusion. Stroke. 1997;28:2081–2083.[Abstract/Free Full Text]
2. Wali JM. "Fou rire prodromique" heralding a brainstem stroke. J Neurol Neurosurg Psychiatry. 1993;56:209–210.[Abstract/Free Full Text]
3. Ceccaldi M, Milandre L. A transient fit of laughter as the inaugural symptom of capsular-thalamic infarction. Neurology. 1994;44:1762.
4. Lago A, Beltrán I, Ferrer JM, Tembl J, Deyá E. Episodio transitorio de risa como sintoma inicial de ictus isquémico. Rev Neurol. 1997;25:239–241.[Medline] [Order article via Infotrieve]

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