Pathological laughter as prodromal manifestation of transient ischemic attacks--case report and brief review.

BACKGROUND: Based on a case report, the authors reviewed the data about involuntary emotional expression disorder (IEED). IEED includes the syndromes of pathological laughing and crying (PLC) and emotional lability (EL). PLC is a rare disorder of emotional expression characterized by relatively uncontrollable episodes of laughter and crying or both that do not have an apparent motivating stimulus. CASE PRESENTATION: Authors report the case of a 59-year-old man who presented with recurrent episodes of PLC of approximately 2 min duration, consisting of accelerated breathing, emission of guttural, snoring sounds, frowning of the eyebrows, followed by laughter accompanied by motor restlessness of all four limbs. PLC episodes preceded left carotid transient ischemic attacks (TIA's) manifested by reversible aphasia and right hemiparesis. Electroencephalography performed during PLC episodes revealed no spike-wave activity. Brain magnetic resonance imaging showed lacunar infarcts in the left lenticulo-capsulo-thalamic area and multiple round lesions in the cortical-subcortical and in the deep white matter of frontal-parietal-occipital lobes bilaterally, with T2 hyperintensity, T1 isointensity and no diffusion changes. The episodes were interpreted as transient ischemic attacks although gelastic seizures could not be excluded. The etiological investigations revealed unstable plaques on the left carotid artery bulb and the aortic arch and a degenerative mitral valve stenosis. The patient was treated first with antiplatelet therapy and antiepileptic drugs but PLC stopped only after anticoagulation was started. During follow-up the patient continued to have left carotid and vertebrobasilar TIA's being on oral anticoagulation. The patient became asymptomatic only after mitral valve replacement was performed. CONCLUSIONS: This case illustrates the difficulty distinguishing between gelastic epilepsy and TIA's in cases of PLC episodes and discuss the neuroanatomic bases and pathophysiology of this rare condition.

ROmanian multicentric study of the prevalence of metabolic syndrome--ROMES.

INTRODUCTION: The metabolic syndrome (MetS) is an entity with a high and continuously increasing prevalence in the modern world. It is of great importance to have actual data about its prevalence. The aim of this study was to assess the prevalence of MetS in a selected population (i.e. patients from cardiology departments) using both NCEP ATP-III and IDF criteria. Secondary objectives were to evaluate the correlation of MetS and abdominal obesity with specific cardiovascular pathology, and to compare the prevalence of MetS according to the two definitions. METHOD: This was a cross-sectional study developed in two parts: the pilot study evaluated all patients admitted to 12 cardiology departments of county hospitals, and the main study included 1176 patients in 15 cardiology departments. RESULTS: The prevalence of MetS in the pilot study (1326 patients, 53.4% men), using only NCEP ATP-III criteria, was 42.8% (45.9% in men and 39.4% in women, p = 0.01), while in the main study (1176 patients, 49.7% men) the prevalence of MetS according to NCEP ATP-III and to IDF criteria was 40.6% (38.3% in men and 42.3% in women) and 44.2% (43.1% in men and 45.3% in women), respectively. MetS represented a risk factor only for stable angina (RR = 1.35, 95% CI = 1.20-1.53, p < 0.001), with no gender difference. CONCLUSIONS: The prevalence of MetS and abdominal obesity is high in a population with cardiovascular disease. Both classifications showed a slightly higher prevalence of MetS in women compared to men. The relative risk of coronary heart disease associated with MetS was statistically significant only for stable angina.