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Pastorkova N, Janouskova K, Vasina L, Schulz H, Astl J, Holy R. Postcovid Guillain-Barré syndrome with severe course - case series two patients including clinical evaluation of smell and examination of olfactory event-related potentials (OERPs). Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37114704 DOI: 10.5507/bp.2023.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION We report a case series two patients of Guillain-Barré syndrome (GBS) associated with previous COVID-19 that both patients survived. GBS is an immune-mediated disease that affects peripheral nerves and can cause life-threatening complications. CASE REPORTS In both cases (53-year-old female and 59-year-old male) with severe GBS with complications, the smell of sense was investigated subjectively using Sniffin' sticks identification tests and objectively using objective olfactometry by the evaluation of olfactory event-related potentials (OERPs). Both patients had good results of the subjective Sniffin' sticks identification test without patholgical findings. Results of objective examination of OERPs: the P2-N1 wave complex was equipotent. No olfactory disturbance could be detected in either case, OERPs were plentiful in both cases. CONCLUSION The presentation of a case series two patients of post-covid GBS are an example of one of the many complications of COVID-19 that can cause prolonged recovery. Despite the severe course of GBS and the long recovery time, both patients returned to normal life. An expanded prospective study is planned for the future to investigate post-covid olfactory impairment. The prevalence of GBS associated with COVID-19 is still unknown but it is evident that both mild and severe forms of GBS have been described in patients.
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Affiliation(s)
- Nikola Pastorkova
- Department of Neurology, Military University Hospital, 169 02 Prague, Czech Republic
| | - Karla Janouskova
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 169 02 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Libor Vasina
- Department of Neurology, Military University Hospital, 169 02 Prague, Czech Republic
| | - Helene Schulz
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Jaromir Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 169 02 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Richard Holy
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 169 02 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
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Červený K, Janoušková K, Vaněčková K, Zavázalová Š, Funda D, Astl J, Holy R. Olfactory Evaluation in Clinical Medical Practice. J Clin Med 2022; 11:jcm11226628. [PMID: 36431104 PMCID: PMC9698169 DOI: 10.3390/jcm11226628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
The subjective and demanding nature of olfactory testing means that it is often neglected in clinic despite loss of smell leading to significant limitations in everyday life. The list of diseases associated with loss of olfaction far exceeds the field of otorhinolaryngology and can also be seen in neurodegenerative disorders. Knowledge of possible clinical testing is essential to determine a proper differential diagnosis for the loss of olfactory sense. Causes of olfactory impairment can be divided into either failure in transferring odour to the organ of perception or damage to the olfactory pathway structure itself. Examination should therefore include methods evaluating cross-sectional area and patency of the nasal cavity as well as subjective or objective assessment of olfactory function. In this report we summarize several articles, studies, and our own experiences to provide a comprehensive review of their current clinical usage including their benefits, limitations, and possible outcomes. We also discuss the mechanism of olfaction step by step to provide a full understanding of the possible errors depending on the localization in the pathway and the methods designed for their detection. We discuss the correlation of the microbiome in nasal polyposis and chronic rhinitis with olfactory impairment using objective olfactometry. The topic of objective olfactometry and the examination of olfactory event-related potentials (OERP) is commented upon in detail.
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Affiliation(s)
- Květoslav Červený
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Karla Janoušková
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Kristýna Vaněčková
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Šárka Zavázalová
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - David Funda
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the CAS, v. v. i., 14220 Prague, Czech Republic
| | - Jaromír Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Richard Holy
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
- Correspondence:
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Limphaibool N, Iwanowski P, Kozubski W, Swidziński T, Frankowska A, Kamińska I, Linkowska-Swidzińska K, Sekula A, Swidziński P, Maciejewska-Szaniec Z, Maciejewska B. Subjective and Objective Assessments of Post-traumatic Olfactory Dysfunction. Front Neurol 2020; 11:970. [PMID: 32982956 PMCID: PMC7479332 DOI: 10.3389/fneur.2020.00970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/24/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction: Traumatic brain injuries are the most common cause of olfactory dysfunction. Deficits in olfaction may be conductive or neurosensory in nature, with varying degrees of impairment resulting in a diminished quality of life and an increased risk for personal injury among patients. The aim of this research is to evaluate the results of the subjective and objective quantitative examinations of olfactory function in a group of patients with post-traumatic anosmia in order to predict its value in identifying olfactory deficits in clinical practice. Materials and Methods: The present study included 38 patients who reported anosmia or hyposmia caused by a traumatic head injury, and a group of 31 age- and sex-matched controls without olfactory dysfunction or prior history of head injury. The comparison of odor perception and identification of two oils (mint and anise) was assessed with the use of blast olfactometry with cortical olfactory event-related potentials. Results: Subjective olfactory tests revealed anosmia or hyposmia in 94% of patients with head injury-related olfactory dysfunction. Objective tests revealed olfactory event-related potentials from cranial nerve I produced by the stimulation with both mint and anise in 20 patients (52.6%). Olfactory event-related potentials from cranial nerve V produced by the stimulation with mint were registered in 26 patients (68.4%). The lack of any responses, from both cranial nerve I and V, was found in 12 patients (32% of cases). Conclusions: Findings from our study indicate the application of both subjective and objective examinations in the evaluation of patients with olfactory impairment. In the diagnosis of post-traumatic anosmia or hyposmia, objective examinations are particularly useful when the patients' level of cognition may be impaired or when subjects may be exaggerating their olfactory defects for a secondary gain. The diagnosis of damage to the olfactory system, specifically in the receptive part of the olfactory pathway, can be established in patients who showed reduced amplitudes or absent cortical responses in addition to absent odor identification and perception threshold in the subjective examination.
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Affiliation(s)
| | - Piotr Iwanowski
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Teodor Swidziński
- Department of Biophysics, Poznan University of Medical Sciences, Poznań, Poland
| | - Anna Frankowska
- Department of Medical Law, Organization and Management in Healthcare, Poznań University of Medical Sciences, Poznań, Poland
| | - Ilona Kamińska
- Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Alicja Sekula
- Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Swidziński
- Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Zofia Maciejewska-Szaniec
- Department of Temporomandibular Joint Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Maciejewska
- Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Poznań, Poland
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Caminiti F, Ciurleo R, De Salvo S, Galletti F, Bramanti P, Marino S. Olfactory event-related potentials in a functionally anosmic patient with arrested hydrocephalus. J Int Med Res 2019; 47:1353-1358. [PMID: 30732509 PMCID: PMC6421394 DOI: 10.1177/0300060519826850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hydrocephalus is one of the lesser known causes of central olfactory loss. The
pathogenesis of hydrocephalus involves the olfactory bulbs or tracts, and more
rarely, other frontotemporal cortical regions. We describe a case of olfactory
dysfunction in a macrocephalic 63-year-old female patient with arrested
hydrocephalus. Her olfactory function was assessed by using the Sniffin’ Sticks
test, olfactory event-related potentials (OERPs), and 3-Tesla magnetic resonance
imaging (MRI). An OERP examination suggested partial impairment of the central
olfactory pathways and central parietal regions where OERP amplitude is maximal.
Indeed, we found an evident olfactory potential trace with an increased latency
only on Pz derivation. However, structural MRI showed important cortical brain
thinning and large expansion of the third ventricle, with evident damage of the
olfactory frontotemporal areas. The Sniffin’ Sticks test and MRI supported the
diagnosis of anosmia, while OERP findings indicated partial preservation of
olfactory function, likely due to an adaptation of the central olfactory system.
These findings highlight the importance of a multi-integrated approach to detect
olfactory impairment.
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Affiliation(s)
| | | | | | - Francesco Galletti
- 2 Department of Otorhinolaryngology, University of Messina, Messina, Italy
| | | | - Silvia Marino
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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Morgan CD, Murphy C. Individuals at risk for Alzheimer's disease show differential patterns of ERP brain activation during odor identification. Behav Brain Funct 2012; 8:37. [PMID: 22849610 PMCID: PMC3542023 DOI: 10.1186/1744-9081-8-37] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 06/15/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies suggest that older adults at risk of developing Alzheimer's disease may show olfactory processing deficits before other signs of dementia appear. METHODS We studied 60 healthy non-demented individuals, half of whom were positive for the genetic risk factor the Apolipoprotein E ε4 allele, in three different age groups. Event-related potentials to visual and olfactory identification tasks were recorded and analyzed for latency and amplitude differences, and plotted via topographical maps. RESULTS Varying patterns of brain activation were observed over the post-stimulus epoch for ε4- versus ε4+ individuals on topographical maps. Individuals with the ε4 allele demonstrated different ERP peak latencies during identification of olfactory but not visual stimuli. High correct ApoE classification rates were obtained utilizing the olfactory ERP. CONCLUSIONS Olfactory ERPs demonstrate functional decline in individuals at risk for Alzheimer's disease at much earlier ages than previously observed, suggesting the potential for pre-clinical detection of AD at very early stages.
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Affiliation(s)
- Charlie D Morgan
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - Claire Murphy
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
- University of California San Diego Medical Center, San Diego, CA, 92120, USA
- SDSU/UCSD Joint Doctoral Program, 6363 Alvarado Ct., Suite 101, San Diego, CA, 92120-4913, USA
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Zamora R, Bartholow J, Green E, Morgan CD, Murphy C. Adiposity measures predict olfactory processing speed in older adult carriers of the apolipoprotein E ε4 allele. Clin Neurophysiol 2012; 123:918-24. [PMID: 22055839 PMCID: PMC3691270 DOI: 10.1016/j.clinph.2011.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 08/25/2011] [Accepted: 09/01/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The current study investigated the relationship between adiposity and P3 latency. METHODS Fifty-one adults in two age groups (18-25 and 65+) participated. Odor stimuli were delivered via olfactometer as participants focused on a computer screen. Each stimulus was followed by presentation on the screen of four odor identification choices. Participants attempted identification by button press. Olfactory event-related potentials (OERPs) were recorded. BMI and waist circumference were measured as indicators of adiposity. RESULTS In bivariate analyses with all participants included, positive correlations for P3 latency with both BMI and waist circumference were observed, indicating that as adiposity increased latencies also increased. When each age group was separately examined, correlations between adiposity measures and latency remained statistically significant for older adults. Furthermore, ApoE ε4 allele status was examined. Latencies remained positively correlated with adiposity in older adult ε4 carriers; but not in non-carriers. CONCLUSIONS This study indicates that adiposity predicts olfactory processing speed in older adults, specifically in ε4 carriers. SIGNIFICANCE The results suggest that olfactory processing speed may be a useful measure for detecting and following the effects of adiposity on brain integrity and cognitive function in those at genetic risk for AD.
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Affiliation(s)
- R Zamora
- San Diego State University, Department of Psychology, USA
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