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Taste and Smell Disorders in Clinical Neurology
TASTE AND SMELL DISORDERS IN CLINICAL NEUROLOGY OUTLINE A. Anatomy and Physiology of the Taste and Smell System B. Quantifying Chemosensory Disturbances C. Common Neurological and Medical Disorders causing Primary Smell Impairment with Secondary Loss of Food Flavors a. Post Traumatic Anosmia b. Medications (prescribed & over the counter) c. Alcohol Abuse d. Neurodegenerative Disorders e. Multiple Sclerosis f. Migraine g. Chronic Medical Disorders (liver and kidney disease, thyroid deficiency, Diabetes). D. Common Neurological and Medical Disorders Causing a Primary Taste disorder with usually Normal Olfactory Function. a. Medications (prescribed and over the counter), b. Toxins (smoking and Radiation Treatments) c. Chronic medical Disorders ( Liver and Kidney Disease, Hypothyroidism, GERD, Diabetes,) d. Neurological Disorders( Bell’s Palsy, Stroke, MS,) e. Intubation during an emergency or for general anesthesia. E. Abnormal Smells and Tastes (Dysosmia and Dysgeusia): Diagnosis and Treatment F. Morbidity of Smell and Taste Impairment. G. Treatment of Smell and Taste Impairment (Education, Counseling ,Changes in Food Preparation) H. Role of Smell Testing in the Diagnosis of Neurodegenerative Disorders 1 BACKGROUND Disorders of taste and smell play a very important role in many neurological conditions such as; head trauma, facial and trigeminal nerve impairment, and many neurodegenerative disorders such as Alzheimer’s, Parkinson Disorders, Lewy Body Disease and Frontal Temporal Dementia. Impaired smell and taste impairs quality of life such as loss of food enjoyment, weight loss or weight gain, decreased appetite and safety concerns such as inability to smell smoke, gas, spoiled food and one’s body odor. Dysosmia and Dysgeusia are very unpleasant disorders that often accompany smell and taste impairments. -
Loss of Taste and Smell After Brain Injury
Loss of taste and smell after brain injury Introduction Following a brain injury many people report that their senses of taste and/or smell have been affected. This may be as a consequence of injury to the nasal passages, damage to the nerves in the nose and mouth, or to areas of the brain itself. Loss or changes to smell and taste are particularly common after severe brain injury or stroke and, if the effects are due to damage to the brain itself, recovery is rare. The effects are also often reported after minor head injuries and recovery in these cases is more common. If recovery does occur, it is usually within a few months of the injury and recovery after more than two years is rare. Sadly, there are no treatments available for loss of taste and smell, so this factsheet is designed to provide practical suggestions on how you can compensate. It provides information on health, safety and hygiene issues, suggestions to help you to maintain a healthy, balanced diet, information on psychological effects and some other issues to consider. How are taste and smell affected by brain injury? The two senses can both be affected in a number of different ways and some definitions of the terms for the different conditions are provided below: Disorders of smell Anosmia Total loss of sense of smell Hyposmia Partial loss of sense of smell Hyperosmia Enhanced sensitivity to odours Phantosmia/Parosmia ‘False’ smells – Perceiving smells that aren’t there Dysosmia Distortion in odour perception Disorders of taste Dysgeusia Distortion or decrease in the sense of taste Ageusia Total loss of sense of taste Dysgensia Persistent abnormal taste Parageusia Perceiving a bad taste in the mouth 1 The two senses are connected and much of the sensation of taste is due to smell, so if the sense of smell is lost then the ability to detect flavour will be greatly affected. -
Smell Distortions: Prevalence, Longevity and Impact of Parosmia in a Population-Based, Longitudinal Study Spanning 10 Years
Smell distortions: Prevalence, longevity and impact of parosmia in a population-based, longitudinal study spanning 10 years Jonas K. Olofsson*1, Fredrik Ekesten1, & Steven Nordin2 1Department of Psychology, Stockholm University, Stockholm, Sweden 2Department of Psychology, Umeå University, Umeå, Sweden *Corresponding author: [email protected] Abstract. Parosmia, experiences of distorted smell sensations, is a common consequence of covid-19. The phenomenon is not well understood in terms of its impact and long-term outcomes. We examined parosmia in a population-based sample from the Betula study that was conducted in Umeå in northern Sweden (baseline data collected in 1998-2000). We used a baseline sample of 2168 individuals aged 35-90 years and with no cognitive impairment at baseline. We investigated the prevalence of parosmia and, using regression analyses, its relationship to other olfactory and cognitive variables and quality of life. Benefitting from the longitudinal study design, we also assessed the persistence of parosmia over 5 and 10 years prospectively. Parosmia was prevalent in 5% of the population (n=104) and was often co- occurring with phantosmia (“olfactory hallucinations”), but was not associated with lower self-rated overall quality of life or poor performance on olfactory or cognitive tests. For some individuals, parosmia was retained 5 years (17%) or even 10 years later (10%). Thus, parosmia is relative common in the population, and can be persistent for some individuals. This work provides rare insights into the expected impact of, and recovery from parosmia, with implications for those suffering from qualitative olfactory dysfunction following covid-19. 2 Introduction Parosmia is an olfactory disorder (OD) where odor perception is distorted and different stimuli trigger unpleasant odor sensations previously not associated with the stimuli (i.e. -
Gamma-Aminobutyric Acid (GABA) Is a Major NeuroTransmitter Widely Distributed Throughout the Central Nervous System (CNS)
Alternative Medicine Review Volume 12, Number 3 2007 Monograph GABA Gamma-Aminobutyric O + Acid (GABA) H3N O- Introduction Gamma-aminobutyric acid (GABA) is a major neuro transmitter widely distributed throughout the central nervous system (CNS). Because too much excitation can lead to irritability, restlessness, insomnia, seizures, and movement disorders, it must be balanced with inhibition. GABA – the most important inhibitory neurotransmitter in the brain – provides this inhibition, acting like a “brake” during times of runaway stress. Medications for anxiety, such as benzodiazepines, stimulate GABA receptors and induce relaxation. Either low GABA levels or decreased GABA function in the brain is associated with several psy- chiatric and neurological disorders, including anxiety, depression, insomnia, and epilepsy. Studies indicate GABA can improve relaxation and enhance sleep. Both synthetic and natural GABA are available as dietary supplements in the United States. Natural GABA is produced via a fermentation process that utilizes Lactobacillus hilgardii – the bacteria used to ferment vegetables in the preparation of the traditional Korean dish known as kimchi. Biochemistry and Pharmacokinetics Within the brain, glutamic acid is converted to GABA via the enzyme glutamate decarboxylase and its cofac- tor pyridoxal 5’ phosphate (P5P; active vitamin B6). GABA is metabolized by gamma-aminobutyrate transaminase, also a P5P-dependent enzyme, forming an intermediate metabolite succinate semialdehyde. This metabolite can then be reduced to gamma-hydroxybutyrate, or oxidized to succinate and eventually converted to CO2 and water via the citric acid cycle. When plasma membrane depolarization induces the release of GABA from nerve terminals, GABA binds to GABA receptors – such as the GABAA and GABAB receptors – that are distributed on post-synaptic cell membranes. -
Let's Talk About . . . Migraine and Dizziness
LET’S TALK ABOUT . MIGRAINE AND DIZZINESS Migraine is almost as common as high blood Key points pressure in the Canadian population. It is more • A migraine is a severe headache. common than asthma or diabetes. An estimated 300,000 Canadians suffer needlessly because they • Of over 300 types of migraine, dizziness is have either been misdiagnosed or not diagnosed a symptom of two: migraine with brainstem with chronic migraine. aura and vestibular migraine. • See a doctor who specialized in headaches for accurate diagnosis. What are the symptoms of migraine with dizziness? • Lifestyle changes may help prevent or lessen the occurrence of migraine. Common symptoms include: • Medication may help prevent migraine. • Visual aura – you may see flashes of light or have blind spots in your vision. • Localized pain behind or near the eye on one Note: Concussion also causes migraine-type side of your head. dizziness – concussion sufferers can substitute the • Light, sound (hyperacusis) and odor sensitivity word “concussion” for “migraine” in the information (hyperosmia). You may have some sensitivity below. daily and increased sensitivity when you have migraine. • Visual vestibular mismatch (the brain’s What is migraine? hypersensitivity to motion) is common in Migraine is a neurovascular headache, meaning it migraine-type brains both episodically and can be triggered by annoyance or disturbance to chronically. Sometimes it will occur without the nerves or blood vessels in the brain. All headache and you may feel “off” for an hour or migraines are caused by the same type of two. neurotransmitter dysregulation and respond to the • Vertigo (spinning sensation) – it may start same treatments. -
Sixty Seconds on . . . Parosmia
NEWS The BMJ BMJ: first published as 10.1136/bmj.m4332 on 9 November 2020. Downloaded from Cite this as: BMJ 2020;371:m4332 Sixty seconds on . parosmia http://dx.doi.org/10.1136/bmj.m4332 Abi Rimmer Published: 09 November 2020 I’ve heard of anosmia but what's this? The charity Fifth Sense explains that parosmia is the medical term for distortions of the sense of smell. Someone with parosmia may be able to detect odours, but the smell of certain things—or sometimes everything—is different, and often unpleasant.1 Such as? Jennifer Spicer, a US based infectious diseases doctor, said that following her recovery from covid-19, coffee, wine, and other foods tasted like gasoline.2 Nicola Watt, who also recovered from the virus, described similar symptoms to the Times.3 “Quite suddenly everything smelt and tasted like a horrid rubbish bin,” Watt said. Sounds awful. Is this from covid-19? Not specifically. Parosmia is common with all types of post-viral smell loss, and over half of people who have lost their sense of smell because of a virus will go on to experience it.4 Fragrance writer Louise Woollam, for example, suffered from parosmia after a cold and found that most foods tasted of sewage or mud and most things smelt disgusting.5 How awful! Yes, and what’s worse Woollam, like many other people, experienced phantosmia as well when “phantom” smells appear in the absence of any odour. These can manifest as “normal” smells – for example, being able to smell garlic when there is no garlic present – but they can also be unpleasant.1 Is there a cure? Unfortunately not. -
Clinical Diagnosis and Treatment of Olfactory Dysfunction
Clinical Diagnosis and Treatment of Olfactory Dysfunction Seok Hyun Cho Hanyang Med Rev 2014;34:107-115 http://dx.doi.org/10.7599/hmr.2014.34.3.107 Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea pISSN 1738-429X eISSN 2234-4446 Olfactory dysfunction is a relatively common disorder that is often under-recognized by Correspondence to: Seok Hyun Cho Department of Otorhinolaryngology-Head both patients and clinicians. It occurs more frequently in older ages and men, and decreases and Neck Surgery, Hanyang University patients’ quality of life, as olfactory dysfunction may affect the emotion and memory func- Hospital, 222 Wangsimni-ro, Seongdong-gu, tions. Three main causes of olfactory dysfunction are sinonasal diseases, upper respiratory Seoul 133-792, Korea Tel: +82-2-2290-8583 viral infection, and head trauma. Olfactory dysfunction is classified quantitatively (hypos- Fax: +82-2-2293-3335 mia and anosmia) and qualitatively (parosmia and phantosmia). From a pathophysiologi- E-mail: [email protected] cal perspective, olfactory dysfunction is also classified by conductive or sensorineural types. All patients with olfactory dysfunction will need a complete history and physical examina- Received 17 April 2014 Revised 23 June 2014 tion to identify any possible or underlying causes and psychophysical olfactory tests are Accepted 3 July 2014 essential to estimate the residual olfactory function, which is the most important prognos- This is an Open Access article distributed under tic factor. CT or MRI may be adjunctively used in some indicated cases such as head trauma the terms of the Creative Commons Attribution and neurodegenerative disorders. -
Olfactory Dysfunction
Olfactory Dysfunction: By Steven Sobol, MD, MSc; Saul Frenkiel, MD, FRCSC; and Debbie Mouadeb he sense of smell plays an important role in protecting Tman from environmental dangers, such as fire, natural gas leaks and spoiled food. Physiologically, the chemical senses aid in normal digestion by triggering gastrointestinal secretions.1 Smell influences the palatability of food. Defects in the sense of smell are associated with alterations in perceptions of flavor, leading to anorexia and weight loss. Psychologically, smell is powerful in establishing strong positive and negative memories, and affects socialization and interpersonal relationships. Smell dysfunctions often mean considerable disability and a lower quality of life. Loss or decreased olfactory function affects approximately one per cent of Americans under the age of 60 and more than half the population over that age.2 Aside from having a substantial impact on an individual’s quality of life, olfactory dysfunction may signal an underlying disease. Smell disorders have been largely overlooked by the medical community because of a lack of knowledge and understanding of the sense of smell and its disease states, as well its diagnosis and management. Patients with olfactory disorders need to be clinically assessed, and the etiology and anatomical location of their disorder should be sought out. The Canadian Journal of Diagnosis / August 2002 55 Olfactory Dysfunction Summary What are the causes of olfactory dysfunction? 1.Conductive olfactory loss is any process that causes sufficient obstruction in the nose preventing odorant molecules from reaching the olfactory epithelium. 2.Sensorineural olfactory loss is any process that directly affects and impairs either the olfactory epithelium or the central olfactory pathways. -
Phantosmia - Advice for Primary Care Dept Clinical Neurosciences and ENT, NHS Lothian
Phantosmia - advice for primary care Dept Clinical Neurosciences and ENT, NHS Lothian. Feb 2021. Phantosmia Phantosmia is the smelling of an odour that isn’t there. It is also called ‘olfactory hallucination’. Hyposmia/anosmia means reduced/loss of sense of smell. Parosmia is when people have an altered sense of smell for something that other people can smell. Key features Phantosmia is a surprisingly common reason for referral to our neurology outpatient Phantosmia is nearly always service. This was the case even before Covid-19 and we anticipate that there will be an benign increase in the problem which is why we made this factsheet. Smells are typically of something burnt, smoky, or Most people with phantosmia report it as an intermittent smell of something burnt, foul foul but can be pleasant. or unpleasant. Cigarette smoke and petrol are common but olfactory experiences can be It can follow on from loss of varied. Sometimes it can be persistent. smell and taste – e.g., after covid-19 What causes Phantosmia? There are many potential causes of phantosmia although most are ‘idiopathic’. In a population study of 2569 Swedish adults over the age of 60, 5% had this symptom. Smoky/Burnt – was the runaway “smell” in this study. Idiopathic – by far the commonest cause Structural – much rarer. Just as people can develop Charles Bonnet visual hallucinations when they can’t see, or musical hallucinations when they can’t hear, so olfactory hallucinations can occur whenever the usual olfactory pathways, either in the nose or brain, are disrupted. Should I be worried about neurological disease? The answer is ‘hardly ever’, especially if 1 in 20 people already have it. -
Olfactory Dysfunction in COVID-19 Diagnosis and Management
Clinical Review & Education JAMA Insights | CLINICAL UPDATE Olfactory Dysfunction in COVID-19 Diagnosis and Management Katherine Lisa Whitcroft, BSc, MBChB; Thomas Hummel, MD As of May 1, 2020, more than 3 000 000 people worldwide have olfactory neuroepithelium may result in inflammatory changes been infected with the novel coronavirus, severe acute respiratory that impair olfactory receptor neuron function, cause subsequent syndrome coronavirus 2 (SARS-CoV-2). The CDC has highlighted key olfactory receptor neuron damage, and/or impair subsequent symptoms that may suggest coronavirus disease 2019 (COVID-19), neurogenesis. Such changes may cause temporary or longer- including cough, shortness of breath or difficulty breathing, fever, lasting OD. Previous work in transgenic animal models showed chills, muscle pain, sore throat, and new loss of smell or taste.1 intracranial entry of SARS-CoV via the olfactory bulb.8 This has led The inclusion of loss of smell or taste among these symptoms to speculation that SARS-CoV-2 may penetrate intracranially with follows the emergence of evidence that suggests that COVID-19 fre- possible downstream effects on olfactory and nonolfactory brain quently impairs the sense of smell. For example, in a study from Iran, regions, which may adversely affect olfactory function. 59 of 60 patients hospitalized with COVID-19 were found to have an impaired sense of smell according to psychophysical olfactory Clinical Assessment testing.2 Olfactory dysfunction (OD), defined as the reduced or dis- During the current pandemic, patients with recent-onset acute torted ability to smell during sniffing (orthonasal olfaction) or eat- smell and/or taste dysfunction, with or without other symptoms of ing (retronasal olfaction), is often reported in mild or even asymp- COVID-19, should undergo a period of self-isolation and, when pos- tomatic cases; in a study from Italy,64% of 202 mildly symptomatic sible, SARS-CoV-2 testing. -
Phantosmia and Migraine with and Without Headache
ISSN 0017-8748 Headache doi: 10.1111/head.12890 VC 2016 American Headache Society Published by Wiley Periodicals, Inc. Expert Opinions Phantosmia and Migraine With and Without Headache Yasmin I. Jion, MD; Brian M. Grosberg, MD; Randolph W. Evans, MD Phantosmia is a rare migraine aura. We present two cases of phantosmias occurring before migraine headaches and also without headaches. To our knowledge, these are the third and fourth cases of phantosmias ever reported due to migraine aura without headache. Key words: phantosmia, olfactory hallucination, migraine, headache (Headache 2016;00:00-00) CASE HISTORIES take acetaminophen with relief in 1–2 hours. Stress Case 1.—This is a 53-year-old female with a 9- was a trigger. month history of smelling a dirty dog smell as often as She saw a cardiologist about 1 month after 2–3 times a day or up to 4 days without the smell with onset and had a CT of the brain without contrast an average duration of 5 minutes (range 30 seconds to on 1/19/15 that was normal. She saw two ENT phy- 1 hour) followed by a headache about every 2 weeks sicians who found normal exams. but most of the time without an associated headache. Past medical history of hyperlipidemia on prav- She described a bifrontal throbbing headache with an astatin. Family history: sister has migraine. Neuro- intensity of 6/10 associated with nausea, light and noise logical examination was normal. sensitivity but no vomiting. She always takes ibuprofen MRI of the brain with and without contrast was with relief in 1 hour. -
Neurological Manifestations As the Predictors of Severity and Mortality
Amanat et al. BMC Neurology (2021) 21:116 https://doi.org/10.1186/s12883-021-02152-5 RESEARCH ARTICLE Open Access Neurological manifestations as the predictors of severity and mortality in hospitalized individuals with COVID-19: a multicenter prospective clinical study Man Amanat1, Nima Rezaei2,3,4, Mehrdad Roozbeh5, Maziar Shojaei6, Abbas Tafakhori7, Anahita Zoghi6, Ilad Alavi Darazam8, Mona Salehi1, Ehsan Karimialavijeh9, Behnam Safarpour Lima6, Amir Garakani10,11, Alexander Vaccaro12 and Mahtab Ramezani13* Abstract Backgrounds: The reports of neurological symptoms are increasing in cases with coronavirus disease 2019 (COVID- 19). This multi-center prospective study was conducted to determine the incidence of neurological manifestations in hospitalized cases with COVID-19 and assess these symptoms as the predictors of severity and death. Methods: Hospitalized males and females with COVID-19 who aged over 18 years were included in the study. They were examined by two neurologists at the time of admission. All survived cases were followed for 8 weeks after discharge and 16 weeks if their symptoms had no improvements. Results: We included 873 participants. Of eligible cases, 122 individuals (13.97%) died during hospitalization. The most common non-neurological manifestations were fever (81.1%), cough (76.1%), fatigue (36.1%), and shortness of breath (27.6%). Aging, male gender, co-morbidity, smoking, hemoptysis, chest tightness, and shortness of breath were associated with increased odds of severe cases and/or mortality. There were 561 (64.3%) cases with smell and taste dysfunctions (hyposmia: 58.6%; anosmia: 41.4%; dysguesia: 100%). They were more common among females (69.7%) and non-smokers (66.7%).