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Differential Diagnosis of Perturbations in Emotion and Affect
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Aside from clinical observation, there are no reliable means of evaluating or quantifying the emotional disorders described above While neurologic medicine has done little more than describe and classify some of the clinical states dominated by emotional derangements, knowledge of this type is nonetheless of both theoretical and practical importance In theory, it prepares one for the next step, of passing from a super cial to a deeper order of inquiry, where questions of pathogenesis and etiology can be broached Practically, it provides certain clues that are useful in differential diagnosis A number of particular neurologic possibilities must always be considered when one is confronted with one of the following clinical states Uninhibited Laughter and Crying and Emotional Lability As indicated earlier, one may con dently assume that the syndrome of forced or spasmodic laughing and crying signi es cerebral disease and more speci cally bilateral disease of the corticobulbar tracts (see Table 25-2) Usually the motor and re ex changes of spastic bulbar (pseudobulbar) palsy described on page 426 are associated, especially heightened facial and mandibular re exes ( jaw jerk ) and often corticospinal tract signs in the limbs as well Extreme emotional lability also indicates bilateral cerebral disease, although only the signs of unilateral disease may be apparent clinically The most common pathologic bases for these clinical states are lacunar infarction or other cerebrovascular lesions, diffuse hypoxic-hypo-
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THE LIMBIC LOBES AND THE NEUROLOGY OF EMOTION
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