title: [Spasmodic laughter syncope. An unusual complication of pseudobulbar palsy].
abstract: BACKGROUND
  Spasmodic laughter is a classical sign of pseudobulbar palsy, but it has never been reported, to our knowledge, to provoke syncope.
  
  
  METHODS
  A 63-year-old hypertensive and diabetic man with peripheral neuropathy and lacunar pseudobulbar palsy presented with three episodes of spasmodic laughter which had induced syncope. No new episode was observed after the beginning of low dose bisoprolol.
  
  
  CONCLUSIONS
  Sustained or spasmodic laughter is accompanied by repetitive bursts of forced expiration, corresponding to short repetitive Valsalva maneuvers. Laughter-induced syncope is considered as one of the many Valsalva-type/vagally mediated syncopal attacks leading to rapid fall in blood pressure without compensatory tachycardia. The presence of autonomic diabetic neuropathy may also contribute to these attacks.
authors.affiliation: Service de neurologie, Hôtel-Dieu de France, Achrafieh, Beyrouth, Liban. awadaadnan@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Awada
authors.forename: G
authors.initials: G
authors.lastname: Halaby
authors.forename: J
authors.initials: J
authors.lastname: Tamraz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D017298:Bisoprolol / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D007845:Laughter / Q000523:psychology*; D008279:Magnetic Resonance Imaging; D008297:Male; D020828:Pseudobulbar Palsy / Q000150:complications* / Q000473:pathology / Q000523:psychology*; D013575:Syncope / Q000209:etiology* / Q000523:psychology*; D014630:Vagus Nerve / Q000502:physiology; D014636:Valsalva Maneuver
chemical_list: D000319:Adrenergic beta-Antagonists; D017298:Bisoprolol