Pseudobulbar Affect in an Elderly Female with Small Vessel Ischemic Disease and Alcohol Abuse Disorder: A Case Report

Pseudobulbar affect (PBA) is a neurological condition characterized by recurrent, inappropriate, and involuntary outbursts of emotion, primarily crying and laughter, which are dissociated from the individual's emotional experience. The precise underlying cause of PBA remains unknown; however, existing evidence suggests the involvement of dopaminergic, serotonergic, and glutamatergic neurotransmission within the corticopontine-cerebellar pathways responsible for regulating the motor expression of emotions. Additionally, PBA has been observed to co-occur with other neurocognitive and psychiatric disorders. Therefore, it is crucial to consider the possibility of a PBA diagnosis in patients with underlying neurological damage and disorders.

In this case report, we present the case of a 66-year-old woman with a medical history of alcohol use disorder and small vessel ischemic disease, who has been experiencing recurrent spontaneous episodes of crying and laughter for the past 2-3 years. These episodes were mood incongruent. A head CT scan without contrast revealed evidence of small vessel ischemia, volume loss without hemorrhage, and mild ventricular enlargement. Despite the emotional episodes, the patient declined treatment due to an affinity for them. Most notable was the cerebellar atrophy observed on sagittal CT without contrast of 2022 admission in comparison to 20202 imaging, which could indicate possible causes of pseudobulbar palsy. This report discusses the patient's presentation, clinical symptoms, diagnosis, and treatment options for PBA, while also shedding light on potential underlying causes of the condition.