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Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine

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ABSTRACT

Pathological laughing and crying, or pseudobulbar affect (PBA), has been described in patients with neurological disorders such as multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, stroke, and traumatic brain injury (TBI) since the 19th century (Schiffer 2005). The syndrome is characterized by inappropriate episodes of laughing or crying after minor stimuli. It was first coined a disinhibition of cortical control by Kinnier Wilson in 1924. It was observed in brain disease and seen with mild TBI. It can impair social and occupational function and is largely underrecognized in clinical settings. PBA is usually treated with antidepressants and dopaminergic agents. In this case we treated a military recruit with TBI with Nuedexta—a dextromethorphan/Quinidine derivative with a subsequent decrease in his episodes.

No MeSH data available.


CNS-LS for PBA. CNS-LS = Center for Neurologic Study-Lability Scale, PBA = pseudobulbar affect.
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Figure 1: CNS-LS for PBA. CNS-LS = Center for Neurologic Study-Lability Scale, PBA = pseudobulbar affect.

Mentions: Physical examination was remarkable only for antalgic gait due to an orthopedic injury to his ankle. His neurological examination was remarkable for the Center for Neurologic Study-Lability Scale (CNS-LS) for PBA of 26, where CNS-LS of 13 or higher is highly suggestive of PBA (Figure 1). His funduscopic examination, cranial nerve, motor, sensory, and cerebellar examination were all normal. He had some difficulty with Romberg testing and gait because of his ankle injury. His reflexes were 2/4, and Babinski testing demonstrated downgoing toes. Laboratory testing was unremarkable, and electrocardiogram was normal. Magnetic resonance imaging of the brain revealed an area of increased signal in the right frontal lobe. However, these lesions had described previously as age appropriate. They have also been seen and described in PBA (Figure 2).


Therapeutic Approach of a High Functioning Individual With Traumatic Brain Injury and Subsequent Emotional Volatility With Features of Pathological Laughter and Crying With Dextromethorphan/Quinidine
CNS-LS for PBA. CNS-LS = Center for Neurologic Study-Lability Scale, PBA = pseudobulbar affect.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998361&req=5

Figure 1: CNS-LS for PBA. CNS-LS = Center for Neurologic Study-Lability Scale, PBA = pseudobulbar affect.
Mentions: Physical examination was remarkable only for antalgic gait due to an orthopedic injury to his ankle. His neurological examination was remarkable for the Center for Neurologic Study-Lability Scale (CNS-LS) for PBA of 26, where CNS-LS of 13 or higher is highly suggestive of PBA (Figure 1). His funduscopic examination, cranial nerve, motor, sensory, and cerebellar examination were all normal. He had some difficulty with Romberg testing and gait because of his ankle injury. His reflexes were 2/4, and Babinski testing demonstrated downgoing toes. Laboratory testing was unremarkable, and electrocardiogram was normal. Magnetic resonance imaging of the brain revealed an area of increased signal in the right frontal lobe. However, these lesions had described previously as age appropriate. They have also been seen and described in PBA (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Pathological laughing and crying, or pseudobulbar affect (PBA), has been described in patients with neurological disorders such as multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, stroke, and traumatic brain injury (TBI) since the 19th century (Schiffer 2005). The syndrome is characterized by inappropriate episodes of laughing or crying after minor stimuli. It was first coined a disinhibition of cortical control by Kinnier Wilson in 1924. It was observed in brain disease and seen with mild TBI. It can impair social and occupational function and is largely underrecognized in clinical settings. PBA is usually treated with antidepressants and dopaminergic agents. In this case we treated a military recruit with TBI with Nuedexta—a dextromethorphan/Quinidine derivative with a subsequent decrease in his episodes.

No MeSH data available.