We present a case of a 63 year old Caucasian right-handed man with a past medical history of bipolar disorder, seizures, and right eye blindness who presents with witzelsucht (chronic or compulsive joking) and moria (childish excitement) suspected after a gunshot wound to the right anterior brain approximately 25 years ago. Mental status exam is normal except for continuous jocularity and disinhibition. While making frequent jokes or puns throughout the Montreal Cognitive Assessment, he managed to score 20/30. Testing was notable for excellent performance on visuospatial/executive tasks, naming, attention and abstraction. He had difficulties with delayed recall, though he could recall items with cues. Despite significant frontal lobe injury, on the Frontal Assessment Battery he scored 15/18, missing points for difficulty on verbal fluency. He was able to perform activities of daily living while needing assistance with some independent activities of daily living. Most recent MRI of the brain shows a large right frontal calvarial defect compatible with craniectomy with cranioplasty and chronic right anterior parenchymal changes.

This case shows that injury to the right anterior brain can leave many aspects of cognition and other frontal lobe functions intact while significantly affecting joking behavior.