Teaching Video NeuroImages: My weeping patient: Avoiding the pitfalls of a functional diagnosis

A 54-year-old man presented with symptoms of a posterior circulation stroke. A right facial palsy and horizontal right end gaze nystagmus was noted. On resolution, episodes of uncontrolled weeping without a provoking stimulus was observed (video at Neurology.org). These were initially unremitting, lasting minutes, with complete resolution after 1 month. An early consideration was of a functional neurologic disorder. Subsequent MRI brain demonstrated bilateral anterior pontine infarcts (figure). It has been hypothesized that pseudobulbar affect (PBA) results from the loss of frontal cortex input to the cerebellum during emotional expression.1 This disruption in descending pathways is postulated in pontine infarcts.2 PBA should not be considered an incongruent sign.
Source: Neurology - Category: Neurology Authors: Tags: All Cerebrovascular disease/Stroke, All Education RESIDENT AND FELLOW SECTION Source Type: research