SEVERE PATHOLOGICAL CRYING AFTER LEFT ANTERIOR CHOROIDAL ARTERY INFARCT - REVERSIBILITY WITH PAROXETINE TREATMENT

Background There is increasing evidence that serotonergic neurotransmi ssion may be damaged In poststroke pathological crying. A correlation between the clinical severity of pathological dying and the size of st roke-induced serotonergic pathway lesions is commonly accepted. We pre sent a case of severe pathological crying after a limited left anterio r choroidal artery territory infarction.Case Description A right-hande d 55-year-old man who was a heavy smoker was admitted to the hospital after a right hemiplegia of sudden onset. Clinical examination reveale d a right global hemiplegia including the face and a right hemihypoest hesia. Cerebral CT scan and MRI showed an infarct in the retrolenticul ar part of the posterior limb of the left internal capsule extending u pward into the posterior paraventricular corona radiata region. Transe sophageal echocardiography revealed an atrial septal aneurysm of 15-mm excursion without associated patent foramen ovale. From the first day of admission, the patient exhibited very frequent and intense fits of pathological crying. Their persistence led to initiation of treatment with the selective serotonin reuptake inhibitor paroxetine on day 30. Complete and immediate resolution of pathological crying occurred 24 hours after onset of therapy. Follow-up examination at day 90 confirme d the absence of relapse of pathological crying. Conclusions We conclu de that poststroke pathological crying in our patient may have been du e to unilateral disruption of the capsular ascending projections of th e serotonergic brain stem raphe nuclei. A small left-sided capsular le sion map have led to severe pathological crying. This disabling condit ion may be reversible with selective serotonin reuptake inhibitor ther apy.