1/7. Post-traumatic olfactory dysfunction.OBJECTIVES: This study demonstrates histopathologic and immunocytochemical changes in the olfactory bulb of a patient with post-traumatic olfactory dysfunction. These results are analyzed in light of current understanding of the pathophysiology of anosmia and dysosmia following head trauma. Emphasis is placed on potential mechanisms of human regeneration and recovery. STUDY DESIGN: The current study documents the history of a patient with the initial complaint of complete anosmia following minor head trauma. Two months after the injury the patient developed persistent, severe dysosmia with debilitating weight loss. Neurosurgical treatment, including removal of the olfactory bulbs and tracts, resulted in permanent resolution of dysosmia. methods: Histopathologic and immunocytochemical analysis of the olfactory bulbs was undertaken and compared with age-matched control tissue. RESULTS: Pathological analysis of the olfactory bulb revealed a marked reduction in the number of nerve processes with few intact olfactory glomeruli compared with an age-matched control. Specific immunohistochemical staining for the olfactory neuron-specific protein OMP, however, demonstrated the presence of intact axonal projections between the olfactory mucosa and the bulb. CONCLUSIONS: These results support the hypothesis that post-traumatic anosmia involves, at least in part, damage to peripheral olfactory nerve fibers with histological changes in the olfactory bulb. Potential mechanisms for the development of post-traumatic dysosmia are also discussed.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
2/7. Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst. Case report.Rathke cleft cysts are commonly found on autopsy but are seldom symptomatic. Conventional treatment of these lesions consists of transsphenoidal drainage with partial excision of the cyst, and recurrence is rare. Alternatively, the instillation of absolute alcohol into the cyst has been described in several reports, with no complications. The authors report on a woman with Rathke cleft cyst that recurred three times after the initial treatment; the lesion was treated with alcohol cauterization on the final recurrence with devastating complications. This 51-year-old woman presented in 1992 with headaches and visual disturbances. Admission magnetic resonance imaging revealed a sellar/suprasellar lesion that was treated with conventional surgery and was subsequently confirmed to be a Rathke cleft cyst. The patient again presented with recurrence of the cyst at 22, 26, and 31 months after the initial presentation. On the final recurrence the cyst was treated with alcohol cauterization. Postoperatively, the patient awoke blind and suffered a seizure from leakage of the alcohol. The patient remains completely blind in both eyes and is also anosmic and has left lid ptosis and exotropia, which signify damage to the first through third cranial nerves. Rathke cleft cysts have been known to recur after primary surgery; however, this is the first report of a single cyst recurring three times despite conventional surgical treatment. Additionally, this is the first report in which devastating complications from alcohol cauterization of the cyst have been described. The authors therefore advocate caution when attempting alcohol cauterization and advise that meticulous care be taken to ensure the patency of the cyst.- - - - - - - - - - ranking = 0.0067265714327827keywords = seizure (Clic here for more details about this article) |
3/7. Gustatory agnosia.OBJECTIVE: To report the assessment of a patient exhibiting gustatory agnosia. methods: Preoperative and postoperative neuropsychological, neuroimaging, and chemosensory evaluations were performed in a 39-year-old woman undergoing surgical treatment for intractable epilepsy. RESULTS: Preoperative MRIs showed bilateral (right > left) atrophy in the medial temporal lobes and complete atrophy of the left insula. Evaluation of gustatory function revealed normal suprathreshold intensity estimation, affective evaluation, and detection thresholds but elevated recognition thresholds. A functional neuroimaging study showed activation to stimulation of aversive taste in the left amygdala. Surgical treatment entailed resection from the left medial temporal lobe that included the region of amygdala that had responded to taste. Postoperatively, detection, naming, and intensity estimation for taste remained normal, but the patient was unable to recognize different tastes (sweet, sour, salty, and bitter). A second evaluation 2.5 years after her surgery revealed no change in taste ability. CONCLUSION: The anteromedial temporal lobe has an important role in recognizing taste quality.- - - - - - - - - - ranking = 0.014221717327547keywords = epilepsy (Clic here for more details about this article) |
4/7. The enigmatic origin of subfrontal schwannomas: report of a case without hyposmia.Subfrontal schwannomas are rare intracranial tumors. Most of them are associated with hyposmia/anosmia. The source of origin of these tumors is still incompletely understood. We report a 23-year-old male who presented with recurrent focal motor seizures, but had no hyposmia. The tumor was completely removed by a subfrontal approach. Relevant literature has been reviewed.- - - - - - - - - - ranking = 0.0067265714327827keywords = seizure (Clic here for more details about this article) |
5/7. Familial 'sleep apnea plus' syndrome: report of a family.We describe a familial disorder consisting of sleep apnea, anosmia, colorblindness, partial complex seizures, and cognitive dysfunction. The phenotypic expression of the syndrome suggests an autosomal dominant inheritance with incomplete penetrance.- - - - - - - - - - ranking = 0.0067265714327827keywords = seizure (Clic here for more details about this article) |
6/7. Psychomotor seizures, arterio-venous malformation and the olfactory reference syndrome. A case report.A case history is reported of a 44-year-old man with a 6-year history of psychomotor seizures. For the past year he had described persistent olfactory hallucinations of an unpleasant nature which he referred to himself. In many respects these symptoms conform to the pattern observed in the olfactory reference syndrome, a recently described but apparently quite discrete psychiatric disorder; there were, however, certain atypical features. At a later stage unilateral anosmia was noted. Radiological examination then demonstrated an arterio-venous malformation in the right frontal lobe. The relationship between the malformation and the psychomotor seizures, and the implications that each has for the development of an olfactory reference syndrome are fully discussed.- - - - - - - - - - ranking = 0.040359428596696keywords = seizure (Clic here for more details about this article) |
7/7. Anosmia following head trauma: preliminary study of steroid treatment.Twenty patients with post-traumatic anosmia were subjected to olfactory function testing, including olfactory acuity tests using a T & T olfactometer and an intravenous olfaction test. T & T tests revealed complete loss in 14 patients. In the intravenous olfaction test, 14 patients showed no response and 5 patients showed abnormal responses. The severity of olfactory dysfunction showed no correlation with background factors such as the site of head trauma, the presence of the fracture of skull, the presence of unconsciousness, or the presence of head operation. As a preliminary study, seventeen patients were administered a corticosteroid, a topical nasal drop of 0.1% betamethasone for 12 patients and an oral administration of prednisolone for 5 patients. Four patients showed slight recovery of olfactory function following a corticosteroid therapy. Effects of corticosteroids on olfaction might be explained by regeneration of olfactory receptor cell axons and reestablishment of contact with cells in the olfactory bulb.- - - - - - - - - - ranking = 0.33333333333333keywords = post-traumatic (Clic here for more details about this article) |