Pseudobulbar Palsy Caused by a Large Petroclival Meningioma: Report of Two Cases

ABSTRACT

Two patients sought treatment for symptoms of bulbar motor dysfunction and the marked emotional lability that characterizes pseudobulbar palsy (PBP). Magnetic resonance (MR) imaging showed large petroclival masses with severe compression and displacement of the brainstem. A suboccipital craniectomy with a transpetrosal, transtentorial approach to the tumor was performed in both patients. One patient required a second-stage surgery to resect an extension of the tumor into the cavernous sinus. In both patients pathological evaluation confirmed the diagnosis of syncytial meningioma. After surgery, PBP resolved in both patients. Large posterior fossa tumors should be included in the differential diagnosis of patients with a clinical picture of bulbar motor dysfunction coupled with emotional lability.

KEYWORDS

Meningioma - pathological laughter - pseudobulbar palsy - tumor

REFERENCES

• 1 Magnus A. Fall von Aufhenbung des Willenseinfulsses auf einige Hirnnerven.  Muller Arch . 1837;  258 256
• 2 Lepine R. Note sur la paralysie glosso-labiee cerebrale a forme pseudo-bulbaire.  Rev Mens Med Chir . 1877;  1 909-922
• 3 Mitsumoto H. Disorders of upper and lower motor neurons. In: Bradley WG, Daroff RB, Fenichel GM, eds. Neurology in Clinical Practice, Vol 1. 2nd ed. Boston: Butterworth-Heinemann, 1996: 261-263
• 4 Adams R D, Victor M, Ropper A H. The limbic lobes and the neurology of emotion. In: Adams RD, Victor M, Ropper AH, eds. Principles of Neurology 6th ed. New York: McGraw-Hill, 1997: 508-521
• 5 Bhatjiwale M G, Nadkarni T D, Desai K I, Goel A. Pathological laughter as a presenting symptom of massive trigeminal neuromas: report of four cases.  Neurosurgery . 2000;  47 469-472
• 6 Cantu R C, Drew J H. Pathological laughing and crying associated with a tumor ventral to the pons.  J Neurosurg . 1966;  24 1024-1026
• 7 Matsuoka S, Aragaki Y, Numaguchi K. A case of angioblastic meningioma with pathological laughter: with special reference to laughter in brain tumor.  Neurol Med Chir (Tokyo) . 1977;  17 195-201
• 8 Matsuoka S, Yokota A, Yasukouchi H. Clival chordoma associated with pathological laughter.  J Neurosurg . 1993;  79 428-433
• 9 Nadkarni T, Goel A. Trochlear nerve neurinoma presenting as pathological laughter.  Br J Neurosurg . 1999;  13 212-213
• 10 Osumi Y, Yamador A, Tamaki N. A case of ventrally situated brainstem meningioma associated with forced laughter.  Rinsho Shinkeigaku . 1976;  16 715-720
• 11 Shafqat S, Elkind M S, Chiocca E A, Takeoka M, Koroshetz W J. Petroclival meningioma presenting with pathological laughter.  Neurology . 1998;  50 1918-1919
• 12 Stevenson G C, Stoney R J, Perkins R K, Adams J E. A transcervical transclival approach to the ventral surface of the brainstem for removal of a clivus chordoma.  J Neurosurg . 1966;  24 544-554
• 13 Achari A N, Colover J. Posterior fossa tumors with pathological laughter.  JAMA . 1976;  235 1469-1471
• 14 Cairns H. Mental disorders with tumours of the pons.  Folia Psychiatr Neurol Jpn . 1957;  53 193-203
• 15 Ironside R. Disorders of laughter due to brain lesions.  Brain . 1956;  79 589-609
• 16 Stern W E, Brown W J. Pathological laughter.  J Neurosurg . 1957;  14 129-139
• 17 Poeck K. Pathological laughter and crying. In: Vinken PJ, Bruyn GW, Klawans HL, eds. Handbook of Clinical Neurology, Vol 45 Amsterdam: North-Holland 1985
• 18 Tsuzaka K, Aimoto Y, Minami N. A case of primary intracranial malignant lymphoma presenting opsoclonus-polymyoclonia syndrome.  Rinsho Shinkeigaku . 1993;  33 194-198
• 19 Wisoff J H, Epstein F J. Pseudobulbar palsy after posterior fossa surgery in children.  Neurosurgery . 1984;  15 707-709
• 20 Hattori S, Kiguchi H, Ishii T, Nakajima T, Yatsuzuka H. Moyamoya disease with concurrent Recklinghausen's disease and cerebral arteriovenous malformation.  Pathol Res Pract . 1998;  194 363-369