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 cases2 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.
- Copyright © 1998 by American Heart Association
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.
Wali JM. “Fou rire prodromique” heralding a brainstem stroke. J Neurol Neurosurg Psychiatry. 1993;56:209–210.
Ceccaldi M, Milandre L. A transient fit of laughter as the inaugural symptom of capsular-thalamic infarction. Neurology. 1994;44:1762.