- Hemidysgeusia, phantosmia and respiratory arrest: a case of CLIPPERS. [Journal Article]
- BCBMJ Case Rep 2019 May 30; 12(5)
- A 56-year-old man presented with a relapse of likely chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) after a reduction of steroid dose. MRI de…
A 56-year-old man presented with a relapse of likely chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) after a reduction of steroid dose. MRI demonstrated new perivascular FLuid-Attenuated Inversion Recovery (FLAIR) signal hyperintensity involving the dorsal pontomedullary junction and progressing inferiorly into the dorsal medulla oblongata. His admission to hospital was complicated by a respiratory arrest.
- 25 Ventriculoperitoneal Shunt as a Meteorologist: Medtronics Shunt Headaches Vaticinating Climatic Perturbation. [Journal Article]
- CSCNS Spectr 2019; 24(1):186-187
- CONCLUSIONS: How climatic changes induce VPS headaches remains unclear. Barometric changes have been reported to cause sinus engorgement [Kaliner 2009], somatic pain [Silove 2006] and can worsen anxiety and depression [Delyukov 1999]. Meteorological parameters may have induced or exacerbated her depression and anxiety, amplifying pain perception. Alternatively, barometric pressure can cause an increase in other somatic pains and stresses, which can augment awareness of additional, unrecognized somatic pains. It is also possible for barometric pressure to cause pain via nasal sinus or mucosal engorgement; thus, mimicking her VPS headache. Lastly, however unlikely, her pain may be a result of a transient VPS malfunction. The mechanism for such can be attributed to transient pressure changes caused by fluctuating blood pressure, inducing brief intrinsic intraperitoneal pressure changes. Nevertheless, querying patients suffering from VPS headacheswhether climatic changes play a role in their symptoms is warranted.Funding Acknowledgements: Smell & Taste Treatment and Research Foundation.
- Management of long-lasting phantosmia: a systematic review. [Journal Article]
- IFInt Forum Allergy Rhinol 2018; 8(7):790-796
- CONCLUSIONS: Despite increasing interest in the treatment of phantosmia and reports of successful therapies, there remains a paucity of data and lack of consensus regarding optimal management of this difficult condition.
- The Association Between Diabetes and Olfactory Function in Adults. [Journal Article]
- CSChem Senses 2017 12 25; 43(1):59-64
- Diabetes is a significant chronic disease that in limited studies has been linked with olfactory dysfunction. We investigated the cross-sectional association between diabetes and olfactory dysfunctio…
Diabetes is a significant chronic disease that in limited studies has been linked with olfactory dysfunction. We investigated the cross-sectional association between diabetes and olfactory dysfunction in 3151 adults aged ≥40 years who participated in US National Health and Nutrition Examination Survey 2013-2014 with information on olfactory dysfunction and diabetes. Diabetes was defined from fasting serum glucose ≥126 mg/dL, oral glucose tolerance test ≥200 mg/dL, HbA1c levels ≥6.5%, physician-diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. Self-reported olfactory dysfunction was defined as a positive answer to any of the following questions: 1) "Have you had problem with smell in the past 12 months?"; 2) "Have you had a change in the ability to smell since age 25?", or 3) "Do you have phantom smells?". Participants were considered to have severe hyposmia or anosmia if they had <5 correct answers in the 8-item pocket smell test. Analyses were adjusted for the main confounders, including olfactory dysfunction risk factors. Compared to non-diabetics, diabetics under insulin treatment showed a higher prevalence of phantom odors [OR(95% CI): 2.42 (1.16; 5.06)] and a non-significant higher prevalence of severe hyposmia/anosmia [OR(95% CI): 1.57 (0.89; 2.78)]. Amongst diabetics, there was a significant trend to severe hyposmia/anosmia for those on more aggressive treatments [OR (95% CI) including oral and insulin treatment compared to those who reported no use of drug treatment, respectively: 1.33 (0.60; 2.96) and 2.86 (1.28; 6.40); P trend 0.01]. No association was observed between diabetes duration and prevalence of olfactory dysfunction.
- Distinguishing Subjective Halitosis. [Case Reports]
- CCCompend Contin Educ Dent 2017; 38(9):e5-e8
- Halitosis is chronic, endogenous malodor that is etiologically classified. Subjective halitosis, which may appear in clinically neurologic (neurogenic) or psychologic (psychogenic) forms, cannot be c…
Halitosis is chronic, endogenous malodor that is etiologically classified. Subjective halitosis, which may appear in clinically neurologic (neurogenic) or psychologic (psychogenic) forms, cannot be confirmed by using tests or performing visual inspection despite insistent complaints of malodor by the patient. Neurogenic forms mainly consist of chemosensory dysfunctions (dysguisa, dysosmia) and self-halitosis (retronasal olfaction, bloodborne olfactory receptor responses, phantosmia); whereas psychogenic forms are olfactory hallucinations, halitophobia, olfactory obsession, and delusional halitosis. This article reports clinically important properties of subjective halitosis that may be difficult to manage and provides a tool to aid dental pracitioners. Practitioners can identify suspected subjective halitosis cases by asking patients simple questions to distinguish between subjective and objective forms.
- Phantosmia and Dysgeusia following Endoscopic Transcribriform Approaches to Olfactory Groove Meningiomas. [Journal Article]
- JNJ Neurol Surg B Skull Base 2017; 78(3):245-250
- The endoscopic, endonasal transcribriform approach (EETA) is an important technique used to directly access the anterior skull base and is increasingly being used in the management of olfactory groov…
The endoscopic, endonasal transcribriform approach (EETA) is an important technique used to directly access the anterior skull base and is increasingly being used in the management of olfactory groove meningiomas (OGMs). As this approach requires removal of the cribriform plate and olfactory epithelium en route to the tumor, patients are anosmic postoperatively. Here, we report the development of phantosmia and dysgeusia in two patients who underwent EETAs for OGMs, which has not yet been reported in the literature. We hypothesize that phantosmia and dysgeusia may result from aberrant neuronal signals or misinterpretation centrally from the remaining distal portions of the olfactory and taste pathways. Since EETAs are newer than traditional open craniotomy-based techniques, reporting these outcomes will be important to appropriately counsel patients preoperatively.
- Migraine with Multiple Sensory Auras. [Case Reports]
- ANActa Neurol Taiwan 2016 Dec 15; 25(4):148-151
- Migraine auras are typically visual in nature but can manifest as disturbances in somatosensory, auditory, and olfactory senses. Reports of multiple sensory auras are rare in the literature, but thei…
Migraine auras are typically visual in nature but can manifest as disturbances in somatosensory, auditory, and olfactory senses. Reports of multiple sensory auras are rare in the literature, but their existence may offer novel insights into the pathogenesis of this highly common yet complex neurological condition. Here we report a case of multiple sensory auras involving somatosensory, auditory, and olfactory disturbances in a patient with migraine without visual manifestations. A 45-year-old woman with a 20-year history of migrainous headaches presented with complaints of rightsided facial and hand numbness and paraesthesia. In addition to somatosensory symptoms, she eventually presented with tinnitus, cutaneous allodynia, and phantosmia, each of which was temporally associated with episodes of headache. No abnormalities were detected on NCS, EEG, MRI, and laboratory investigations. Her symptoms were managed by prophylactic medications and acupuncture. The theories of cortical spreading depression, cortical sensitization, and thalamocortical network involvement were discussed as possible explanations for sensory auras in migraine. This case report of migraine with multiple sensory auras spanning somatosensory, auditory, and olfactory modalities offers novel insights into the pathophysiology of migrainous auras.
- Phantom Smells: Prevalence and Correlates in a Population-Based Sample of Older Adults. [Journal Article]
- CSChem Senses 2017 05 01; 42(4):309-318
- Loss of olfactory function is common in old age, but evidence regarding qualitative olfactory dysfunction in the general older population is scarce. The current study investigates the prevalence and …
Loss of olfactory function is common in old age, but evidence regarding qualitative olfactory dysfunction in the general older population is scarce. The current study investigates the prevalence and correlates of phantom smell experiences (phantosmia) in a population-based study (Swedish National Study on Aging and Care in Kungsholmen [SNAC-K]) of Swedish adults (n = 2569) aged between 60 and 90 years. Phantosmia was assessed through a standardized interview and defined as reporting having experienced an odor percept in the absence of any stimuli in the surrounding environment that could emit the odor. The relationships between phantosmia and demographic, genetic, health-related, and behavioral variables were analyzed with hierarchical logistic regression analyses. The overall prevalence of phantom smells was 4.9%, and was associated with female gender, carrying the met allele of the BDNF gene, higher vascular risk burden, and reporting distorted smell sensations (parosmia). Olfactory dysfunction was, however, not related to phantosmia. The most frequently reported phantom smell was smoky/burnt. A novel finding was that some individuals reported phantom smells with an autobiographical connotation. The results from this study indicate that the prevalence of phantosmia in the general older population is not negligible and that some factors that are beneficial for preserved olfactory function, such as female gender and the BDNF met allele, are also associated with the occurrence of phantom smells.
- Might the olfactory bulb be an origin of olfactory auras in focal epilepsy? [Review]
- EDEpileptic Disord 2016 Dec 01; 18(4):344-355
- Olfactory auras (phantosmia) are an infrequent phenomenon in complex focal seizures generated in the mesial temporal lobe. It is generally assumed that all such auras arise from epileptic foci in the…
Olfactory auras (phantosmia) are an infrequent phenomenon in complex focal seizures generated in the mesial temporal lobe. It is generally assumed that all such auras arise from epileptic foci in the entorhinal cortex, amygdala or rostral insula, all of which have major afferent projections from the olfactory bulb or mainly from its relay, the anterior olfactory nucleus. The histological morphology, synaptic circuitry, and foetal development of the olfactory bulb are unique. The olfactory system is the only special sensory system that does not project to the thalamus because its bulb and tract incorporate an intrinsic thalamic equivalent: axonless granular and periglomerular neurons and the anterior olfactory nucleus. The olfactory bulb exhibits continuous synaptic turnover throughout life. Other brain structures with synaptic plasticity (neocortex, hippocampus, and amygdala) are epileptogenic; synaptically stable structures (brainstem, cerebellum, and basal ganglia) are not epileptogenic. Electrophysiological and neuropathological data of the olfactory bulb in epilepsy are sparse. We propose an alternative hypothesis, first hinted in 1954 by Penfield and Jasper, that some epileptic olfactory auras are primarily generated by the olfactory bulb and secondarily mediated by the amygdala and entorhinal cortex.
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- Olfactory symptoms reported by migraineurs with and without auras. [Journal Article]
- HHeadache 2016; 56(10):1608-1616
- CONCLUSIONS: Odor-related disturbances were common symptoms of the 113 migraineurs, with nearly all reporting osmophobia. Perfume odor was the most common trigger for the migraine. The reported symptoms did not differ between patients with and without auras. Patients who experienced IOH appeared to fundamentally differ from those who did not experience IOH in terms of the incidence of osmophobia and odor-triggered crisis. Subjects who reported experiencing osmophobia and odor-triggered headache reported having worse olfactory acuity.