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Laughter is no joke:  Can laughter kill you?

Dr Sampurna Roy MD      


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Over the past 30 years, there has been much research about the health benefits of humour and laughter.

Hundreds of articles and blog posts have been written on the positive effects of laughter on our health, body and mind.

Acronyms like LOL, ROFL, LMAO has become part of our everyday online communication. 

However, laughter is not always the best medicine. 

Uncontrolled laughter can have harmful effect on every organ of the body.

Pathological laughter is an ominous sign of lesion in the brain.





Laughter causing serious disorder in various organs:

Cardiovascular system: Laughter can cause left bundle branch block, cardiac rupture, arrythmia, heart failure and syncope. 

Respiratory system:  In asthmatic patients laughter trigger an attack.

In these patients cough is more common than wheeze. 

Pilgaard-Dahl syndrome, is pneumothorax in middle-aged male smokers induced by laughter.

Interlobular emphysema has been reported due to excessive laughter.

Foreign bodies may be inhaled due to quick breathing during laughter and can choke the patient.

Central nervous system: Excessive laughter can cause severe headache.

The Chiari malformation and colloid cysts of the third ventricle are occasionally associated with laughter induced headache.

A patient with a patent foramen ovale laughed for few minutes and became aphasic. Later the patient had a cerebral infarct.

Cataplexy, is characterised by sudden loss of muscle tone provoked by laughter and other stimuli.

Gastrointestinal system:  Boerhaave’s syndrome is a dangerous condition characterised by spontaneous oesophageal perforation.

Hearty laughter can make a hernia protrude.

The patient may complain of severe abdominal pain after prolonged laughter.

Genitourinary system: Laughter can cause stress incontinence,"giggle incontinence" or giggle micturation. 

This could be due to contraction of detrusor muscle due to uncontrolled giggling.

Other dangerous consequence of laughter is jaw dislocation and rectus muscle haematoma of the abdomen.

Infectious laughter can also disseminate real infection.






                Neuroma                          Ependymoma


              Glioma                                      Schwannoma


           Glioblastoma                          Meningioma


                Rathke cleft cyst                        Chordoma


Pathological Laughter:

Crazy laughter was first described in 1903 as a prodromic symptom of an ischemic stroke and was later associated with brain lesions having a different location and etiology.

The patients usually  present with episodes of laughter which would last 2 to 3 min and a simple act of smiling at the patients would provoke an attack of uncontrollable laughter.

Pathological laughter can be present in some neurological conditions including posterior fossa tumours.

It is believed to be related to brain stem compression and disruption of its intrinsic pathways and connections to supra tentorial regions, as stated in various reports.

Complete relief of the condition can be expected after surgical treatment and decompression of the brain stem.

The following are some of the important conditions leading to pathological laughter:

1) Hypothalamic Hamartoma-   Gelastic seizure is a rare form of epilepsy defined as automatic bouts of laughter without mirth. 

It is often associated with a hypothalamic hamartoma.

Associated clinical features included behavioral disorders  developmental delay and precocious puberty.

2) Trigeminal neuroma or schwannoma - Patients with trigeminal neuromas and schwannomas can present with sudden bursts of laughter.

On neurological examination the patient may present with VI nerve palsy.

After resection there is complete remission of the unmotivated laughing episodes.

No recurrence of laughter and crying attacks were noted after total removal of the tumour.

3) Meningioma- Pathological laughter may be an early focal sign of a mass compressing ventrolateral brainstem.

Patients with tentotrial and petroclival meningioma present with involuntary and inappropriate laughter.

The meningiomas in these areas are well defined and only moderately vascular, and can be easily resected. 

The pathological laughter cease  immediately after removal of the tumour.

4) Cerebellar ependymoma - Patient has a history of syncope following intense and uncoordinated laughter.

5) Pontine gliomas-   Children with pontine glioma showed marked behavioural changes like "pathological laughter" together with ataxia, motor deficits and cranial nerve palsies.  

6) Frontal glioblastoma - Invasive tumor in the frontal lobe involving the prefrontal cortex and subcortical structure may cause pathological laughter, and can be cured by surgery.

7) Rathke cleft cysts  arises from embryonic remnants of Rathke's pouch, and usually manifest as headaches, visual impairments and endocrine disturbances.

This lesion can sometimes present as pathological laughter as primary symptom.

8) Clival chordoma: Chordomas are rare, slowly growing tumours that probably originate from the remnants of the notochord.

A male patient presented with symptoms due to compression of the brain stem and hypothalamus, including the unusual manifestation of pathological laughter.

9) Angelman (happy puppet) syndrome:  Disorder is characterised by global development delay, ataxia, episodes of paroxysmal laughter, seizures, and microcephaly.

The facial appearance is characterised by a prominent jaw, a wide mouth, and a pointed chin.

Tongue thrusting is common.

The movement disorder consists of a wide based, ataxic gait with frequent jerky limb movements and flapping of the hands.

Other causes of pathological laughter are multiple sclerosis and amyotrophic lateral sclerosis or motor neuron disease.


Recently Turkey's deputy prime minister has been mocked on social media after saying women should not laugh out loudly in public. I certainly don't agree with his reasons.

As a pathologist my message is to both men and women. 

If you are an ashmatic patient keep the inhaler by your side.

Avoid giggling hysterically when you are eating your meal.  

ROFL, if you are really rolling on the floor laughing, make sure that the floor is clean and that you don't have any history of hernia or heart disease.

I still agree to the quotation - "A good laugh and a long sleep are the best cures in the doctor's book" - Irish quotation



Laughter and MIRTH (Methodical Investigation of Risibility, Therapeutic and Harmful): narrative synthesis. RE Ferner JK Aronson BMJ 2013;347:f7274 (Published 12 December 2013)

Laughter-induced syncope: no laughing matter.

Fall about laughing: a case of laughter syncope.

Laugh syncope as a rare sub-type of the situational syncopes: a case report.

Laughter-induced syncope. 

Laughter-induced left bundle branch block.

Shear hilarity leading to laugh syncope in a healthy man.

Three months’ palpitation at twenty. 

Fatal laughter.

Five cases of spontaneous rupture of the heart. 

A review of thirty-three cases of foreign bodies in the oesophagus, bronchi and larynx. 

Should asthmatic patients laugh?  

Mirth-triggered asthma: is laughter really the best medicine? 

Unusual triggers for stroke.

Giggle incontinence.  

The laughing hernia sign. 

Boerhaave’s syndrome. 

Rectus sheath haematoma: a rare presentation of non-contact strenuous exercises. 

Pathological laughter as a presenting symptom of massive trigeminal neuromas:report of four cases.

Giant clival chordoma causing pathological laughter.

Gelastic epilepsy and hypothalamic hamartomas: neuroanatomical analysis of brain lesions in 100 patients.

A cognitive and affective pattern in posterior fossa strokes in children: a case series.

A successful surgical case of a hypothalamic hamartoma with gelastic seizure: a case report.

Transient mutism and pathologic laughter in the course of cerebellitis.

Pathological laughter in a patient with Rathke cleft cyst.

Pathological laughter caused by frontal glioblastoma: case report.

Intractable gelastic seizures during infancy: ictal positron emission tomography (PET) demonstrating epileptiform activity within the hypothalamic hamartoma.

Cerebellar tumour presenting with pathological laughter and gelastic syncope.

Pathological laughter in trigeminal schwannoma: case report and review of the literature.

Pediatric-onset gelastic seizures: clinical data and outcome.

Pathological laughter and behavioural change in childhood pontine glioma.

Crazy laughter: first manifestation of a pontine tumour.


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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)







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