Case studies A condition rarely diagnosed,<unk>  has been well documented in the recent era in at least two cases: Case #1: A 30-year-old, right-handed man was admitted to the department of neurology for irritability, inappropriate behavior, and morbid hyperphagia with obesity. His inappropriate laughter and persistent pun and joke telling was a sharp contrast to his personality as an intellectual theological scholar, known for his exceptional memory as opposed to his sense of humor. This behavior was generally prompted by environmental stimuli such as physician’s rounds or blood sampling. To the patient, his behavior seemed normal, which explains why he remained nondiscriminating toward his jokes, their context, and their impression on those around him. Neurological examination revealed mild spastic left hemiparesis with minimal motor coordination and impairment of voluntary fine movements. Single-photon emission computed tomography (SPECT) showed hypoperfusion, or decreased blood flow, in the right frontoparietal area. Additionally, verbal and performance tests showed evidence of poor concentration skills, high distractibility, and difficulty with visual-spatial tasks. The patient’s performance on the Wisconsin Card Sorting Test was severely impaired, suggesting frontal dysfunction. Case #2: A 56-year-old man, KS, was admitted to the hospital with signs of a putaminal hemorrhage, including dense paralysis on the left side of his body and face, difficulty swallowing, and visual field defects on his left side. On the fifth day of hospitalization, he was alert and cooperative with no disorientation, delusion, or emotional lability. He then became euphoric and outspoken, speaking in puns and witticisms with an exaggerated smile. The content of his conversations, however, was not bizarre or random. He would work in puns and jokes while speaking his concerns about his other physical symptoms from the stroke in a coherent manner. Sometimes he would not crack a smile at something he said to make others around him laugh hysterically, while other times he could not appreciate others' jokes. During this time, KS also developed hypersexuality, using erotic words and inappropriate behavior toward the female hospital staff. Before his stroke, KS's family reported he did make jokes on occasion, but never in this bizarre manner, and never behaved impolitely to women. MRI tests showed bleeding at the right putamen, extending into the posterior and lateral portions of the right thalamus and defects in the thalamus and right basal ganglion. Another test showed deficits in recent memory, orientation, abstract thinking, drawing, and verbal fluency. Altered sense of humor In both case studies, patients showed an altered sense of humor, mostly in regard to producing and appreciating humor. The right hemisphere is involved with processing speed and problem solving, which plays a role in humor processing. These patients have difficulty fully interpreting a joke's content, but can recognize the importance of the form of a joke. Patients with<unk>  often find non sequiturs, slapstick humor, and puns funniest since these forms of humor do not require integration of content across sentences. In other words, the end of the joke is not dependent on the first part; one does not need to make a logical connection to understand humor. Patients show no change in understanding simple logic, and understand the importance of surprise in humor (hence why they choose slapstick humor instead of the “correct” punch line); however, once they have registered this surprise, they cannot connect the punch line to the body of the joke to fully appreciate the true humor behind the joke. Successful jokes require a juxtaposition of the sound and the meaning of words used to understand the punchline. However, patients with<unk>  have difficulty connecting the two, resulting in an inability to appreciate humor. Additionally, patients show no emotional reaction to humor, whether produced by themselves or others. This lack of responsiveness is due to dissociation between their cognitive and affective responses to humorous stimuli. That is, even when a patient understands that a joke is funny (based on quantitative brain activity), they do not respond with laughter, or even a smile. While they have grasped the cognitive basis of humor, they do not affectively respond. This is also considered a cognitive component of empathy, affecting one's ability to take the perspective of others; hence why patients often do not respond to humor produced by other people. Hypersexuality This symptom is much rarer than the unusual use of puns and nonresponsive sense of humor most notably seen in<unk>  patients. Nonetheless, patients can still exhibit hypersexuality by making sexual comments at socially inappropriate times. Some signs of this behavior include impulsivity, poor judgment, deficits in emotional regulation, excess preoccupation with sex, and cognitive rigidity (difficulty in appreciating another’s emotion, inability to yield). More than likely this symptom is linked to amygdala damage that can occur during a stroke, which can also induce frontal lobe damage.
Witzelsucht
Mittelschmerz
Dollond
Pendelluft
Billrothhaus
Stromuhr
Pill organizer
Zellballen