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.
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.
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.
[6] 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.
Anatomically, there are meaningful connections between the frontal lobes (specifically the polar and ventral/medial areas) and other brain regions related to affective-emotional responses.
The frontal lobes are also involved in processing narrative conversation and understanding abstract or indirect forms of communication, such as sarcasm.
Subjects with damage to the right superior frontal cortex (Brodmann areas 8/9) choose punchlines which are simplistic and do not integrate content across a narrative.
This region of the brain is responsible for problem-solving skills and holding information to recall during processing (i.e. working memory).
It has been considered a heteromodal cortex, which means that it responds to multiple stimuli, capable of interpreting internal and external sensory input.
The coordination of these sensory interpretations are ideal for humor appreciation and production, one of the highest and most evolved human cognitive functions.
This logical process is an important role in the frontal lobes; therefore, damage to this area of the brain leads to difficulty connecting the start of a joke to the punch-line.
In incongruity-resolution, there is more information to be integrated within the frontal lobe (i.e. when the joke makes more sense, in a somewhat logical way, the scripts within the brain can be unified better.)
Patients with Witzelsucht cannot make that logical connection in incongruity-resolution jokes, hence why they communicate through nonsense humor, mostly in the form of puns and non sequiturs.
[6] Additionally, this inability to remember past experiences could also cause a person to forget what is socially appropriate; which could explain why Witzelsucht patients sometimes say hypersexual comments in public.
The amygdala plays a significant role in processing emotional stimuli and producing affective responses, which in turn is utilized in social interactions.
There are a range of neuropsychiatric symptoms associated with frontal lobe dementia, including progressive declines in social conduct, insight, and personal and emotional regulation and reactivity.
[14] Serotonin and norepinephrine reuptake inhibitor, venlafaxine, were given to case study KS four months after initial stroke that started symptoms of witzelsucht.